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PRIMITIVE  TREPHINING  IN  PERU 

BY 

MANUEL  ANTONIO  MUNIZ,  M.  ID., 

AND 


W J McG-EE 


/ <3  / / 


PREFATORY  NOTE 


During  several  years  prior  to  1893,  Dr  Manuel  Antonio  Muniz, 
some  time  Surgeon-General  of  the  Army. of  Peru,  traveled  extensively 
through  the  ancient  land  of  the  Incas,  and  made  large  collections  from 
the  huacals  and  scattered  graves  of  the  Andean  valleys  and  the  des- 
iccated Piedmont  zone  inclining  from  the  Cordillera  toward  Pacific 
ocean.  Lowland  Peru  is  arid,  and  even  the  rugged  highlands  fronting 
the  Pacific  receive  but  limited  rainfall;  and  by  reason  of  a combina- 
tion of  conditions  the  air  and  so  the  soil  are  dry  nearly  all  the  year, 
and  in  some  places  the  ground  is  saline  or  nitrous.  Accordingly 
organic  matter  buried  in  the  earth  is  preserved  in  a manner  hardly 
conceivable  to  those  accustomed  to  the  conditions  of  humid  lands;  and 
thus  Dr  Muniz’  explorations  were  remarkably  fruitful. 

The  material  collected  from  the  long-neglected  tombs  of  Peru  by  Dr 
Muniz  comprised  weapons  of  war  and  the  chase,  implements  in  wide 
variety,  domestic  utensils,  costum ery  of  skins  and  stuffs,  and  articles 
of  adornment,  all  in  considerable  quantity;  though  his  tastes  and  train- 
ing led  him  to  devote  especial  attention  to  the  somatic  remains  of  the 
ancient  people.  His  collection  comprised  something  over  a thousand 
crania;  of  these,  nineteen  were  found  to  be  trephined,  several  more 
than  once. 

In  1893  Dr  Muniz  attended  the  “International  Congress  of  Anthro- 
pology of  the  World’s  Congress  Auxiliary  of  the  World’s  Columbian 
Exposition”  at  Chicago,  for  the  purpose  of  exhibiting  and  describing 
the  trephined  crania.  His  formal  communication,  translated  into  Eng- 
lish, forms  the  accompanying  “summary  statement.”  Afterward  he 
attended  the  Pan-American  Medical  Congress  at  Washington,  and 
exhibited  the  collection  informally;  and  still  later  he  transferred  its 
custody  to  the  writer,  on  behalf  of  the  Bureau  of  American  Ethnology, 
for  use  in  preparing  the  accompanying  description  of  the  remarkably 
interesting  series  of  specimens  of  primitive  surgery. 

On  his  return  to  Lima,  toward  the  end  of  1893,  Dr  Muniz  had  the  mis- 
fortune to  encounter  a political  movement;  before  it  ended  his  house  was 
sacked  and  burned,  his  library  and  his  rich  collections  were  destroyed, 
and  he  was  exiled.  Of  all  of  the  areheologic  material  brought  together 
during  his  years  of  labor,  only  the  collection  of  trephined  crania  remains; 
and  the  energetic  collector  has  insured  the  safety  of  this  remnant  by 

5 


6 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


transferring  it  to  the  Bureau  of  American  Ethnology  for  preservation  in 
the  United  States  National  Museum,  save  for  a single  specimen  (the 
triple-trephined  cranium,  from  Cuzco)  which  has  been  placed  in  the 
United  States  Army  Medical  Museum. 

The  Mufiiz  crania  have  been  examined  by  mauy  scientific  and  medi- 
cal men  in  the  United  States;  since  they  were  brought  before  the 
World’s  Congress  at  Chicago  and  the  members  of  the  Pan-American 
Congress  at  Washington,  they  have  been  exhibited  and  discussed  before 
the  Anthropological  Society  of  Washington,  the  Archeological  Associa- 
tion of  Philadelphia,  the  Medical  Society  of  the  District  of  Columbia, 
Washington,  and  the  Historical  Club  of  Johns  Hopkins  Hospital,  Bal- 
timore; and  in  addition  they  have  been  inspected  by  many  visitors  to 
the  Bureau.  The  accompanying  description  has  been  prepared  in  the 
light  of  much  discussion  concerning  the  collection,  and  is  framed  to 
answer,  so  far  as  may  be,  the  principal  inquiries  made  by  students. 
As  originally  made,  the  collection  of  trephined  crania  was  supple- 
mented and  illumined  by  the  collateral  objects  representing  the  arts  of 
the  primitive  trephiners;  but  since  the  remainder  of  the  collection  is, 
unhappily,  lost  irretrievably,  it  has  been  deemed  desirable  so  to  extend 
the  description  and  discussion  of  the  crania  and  the  details  of  the  opera- 
tion as  to  render  the  series  self-explanatory  in  every  respect.  It  may, 
however,  be  noted  that  the  inferences  as  to  methods  and  motives  are  in 
precise  accord  with  the  testimony  of  associated  objects.  For  purposes 
of  comparison,  illustrations  of  the  ‘-Inca  skull”  brought  from  Peru  by 
the  late  E.  G.  Squier,  and  of  eight  trephined  crania  preserved  in  the 
Municipal  Museum  at  Cuzco,  are  introduced.  A more  exhaustive  dis- 
cussion of  primitive  trephining  in  Peru  by  Dr  Mufiiz  may  be  looked  for 
in  the  future. 

For  the  arduous  duty  of  making  the  collection  and  establishing  the 
authenticity  of  the  specimens  through  careful  study  of  associations, 
and  for  the  accompanying  summary  statement,  Dr  Muniz  deserves  the 
credit  and  bears  the  responsibility;  for  the  remaining  portion  of  the 
paper  and  for  the  fidelity  of  the  illustrations  the  writer  is  responsible. 
The  respective  authorial  responsibility  is  indicated  .specifically  by 
initials  in  the  list  of  contents  and  in  the  principal  subtitles. 


W J M.« 


CONTENTS 


Page 

Summary  statement  (M.  A.  M.) 11 

Description  and  discussion  of  the  Peruvian  crania  (W  JM.) 14 

The  collectiou 14 

Trephining  in  general. 15 

Distribution.. 15 

Classification 17 

Origin  and  development 19 

The  crania  in  detail 25 

Common  features 25 

Cranium  1 26 

Cranium  2 28 

Cranium  3 29 

Cranium  4 29 

Cranium  5 30 

Cranium  6 31 

Cranium  7 32 

Cranium  8 34 

Cranium  9 35 

Cranium  10 35 

Cranium  11 36 

Cranium  12 37 

Cranium  13 38 

Cranium  14 40 

Cranium  15 43 

Cranium  16 45 

Cranium  17 47 

Cranium  18 49 

Cranium  19 52 

Method  of  operating 55 

Instruments 58 

Procedure  of  the  operators 61 

The  motive  for  operating 63 

General  indications  of  motive 63 

Special  indications  of  motive 67 

Classification  of  Peruvian  trephining 71 

Significance  of  Peruvian  trephining 72 


7 


ILLUSTRATIONS 


Page 

Plate  I.  Superior  aspect  of  cranium  1,  from  Huarochiri 27 

II.  Left  lateral  aspect  of  cranium  1 27 

III.  Anterior  aspect  of  Squier’s  “Inca  skull” 27 

IV.  Posterior  aspect  of  cranium  2,  from  Huarochiri 29 

V.  Eight  lateral  aspect  of  cranium  2 29 

VI.  Superior  aspect  of  cranium  3,  from  Canete. 29 

VII.  Right  lateral  aspect  of  cranium  3 29 

VIII.  Anterior  aspect  of  cranium  4,  from  Huarochiri 31 

IX.  Superior  aspect  of  cranium  4 31 

X.  Anterior  aspect  of  cranium  5,  from  Huarochiri 31 

XI.  Superior  aspect  of  cranium  5 31 

XII.  Eight  latero-postero-superior  aspect  (inverted)  of  cranium 

6,  from  Huarochiri 33 

XIII.  Anterior  aspect  of  cranium  7,  from  Cuzco  (double-trephined''.  33 

XIV.  Left  lateral  aspect  of  cranium  7 33 

XV.  Posterior  aspect  of  cranium  7 33 

XVI.  Superior  aspect  (inverted)  of  cranium  8,  from  Huarochiri  . . 35 

XVII.  Anterior  aspect  of  cranium  9,  from  Huarochiri 35 

XVIII.  Left  lateral  aspect  of  cranium  9 35 

XIX.  Posterior  aspect  of  cranium  10,  from  Cuzco 37 

XX.  Eight  lateral  aspect  of  cranium  10 37 

XXI.  Anterior  aspect  of  cranium  11,  from  Pachacamac 37 

XXII.  Eight  lateral  aspect  of  cranium  11 37 

XXIII.  Posterior  aspect  of  cranium  12,  from  Cuzco  (double-tre- 
phined)  39 

XXIV.  Right  lateral  aspect  of  cranium  12 39 

XXV.  Superior  aspect  of  cranium  13,  from  Cuzco  (double-tre- 
phined)   39 

XXVI.  Pour  crania  preserved  in  museum  at  Cuzco 40 

XXVII.  Four  crania  preserved  in  museum  at  Cuzco 40 

XXVIII.  Anterior  aspect  of  cranium  14,  from  Huarochiri 42 

XXIX.  Left  latero-anterior  aspect  of  cranium  14 42 

XXX.  Superior  aspect  of  cranium  15,  from  Huarochiri 45 

XXXI.  Left  lateral  aspect  of  cranium  15 45 

XXXII.  Left  latero-postero-superior  aspect  of  cranium  15 45 

XXXIII.  Right  lateral  aspect  of  cranium  16,  from  Huarochiri 47 

XXXIV.  Postero-inferior  aspect  of  cranium  16 47 

XXXV.  Left  lateral  aspect  of  cranium  17,  from  Tarma 49 

XXXVI.  Anterior  aspect  of  cranium  17 49 

XXXVII.  Superior  aspect  of  craniumlS,  from  Cuzco  (triple-trephined).  51 

XXXVIII.  Left  lateral  aspect  of  cranium  18 51 

XXXIX.  Anterior  aspect  of  cranium  19,  from  Huarochiri 53 

XL.  Right  lateral  aspect  of  cranium  19 55 


9 


PRIMITIVE  TREPHINING-  IN  PERU 


By  Manuel  Antonio  Muniz,  M.  D.,  and  W J McGee 


SUMMARY  STATEMENT 


(M.  A.  M.) 

Much  has  been  .written  on  prehistoric  trephining,  and  it  is  a well- 
understood  fact  that  in  the  ancient  villages  of  this  and  of  the  Old 
World,  and  even  in  some  of  the  settlements  of  the  present  savages, 
trephining  has  been  known  and  practiced,  not  only  for  religious  pur- 
poses but  also  for  surgical  purposes,  to  effect  a cure  of  disorders  con- 
sequent on  traumatic  lesions  of  the  cranium  and  also  as  a means  of 
treating  certain  cerebral  diseases. 

Therefore  the  historico-bibliographic  matters  with  which  every  arche- 
ologist is  perfectly  well  acquainted  may  be  omitted. 

If  we  take  into  account  the  class  of  offensive  weapons  used  by  the 
ancient  Peruvians  in  their  terrible  conflicts,  almost  hand  to  hand,  it 
will  easily  be  comprehended  that  complex  fracture  of  the  skull  with 
depression  of  its  bony  plates  must  have  been  very  common.  In  fact, 
they  were  accustomed  to  throw  stones  of  more  or  less  round  or  irregu- 
lar shape  to  great  distances  ivith  high  initial  velocity  by  means  of  the 
sling;  they  were  also  armed  with  large  wooden  clubs,  extremely  hard, 
in  the  ends  of  which  splints  of  copper  or  stone  were  fastened,  as  well 
as  hatchets  of  both  these  materials  and  of  diverse  forms. 

Without  treating  of  the  order  in  which  the  different  civilizations  of 
ancient  Peru  were  developed  and  gained  predominance,  it  may  only  be 
observed  that  it  is  certain  the  aborigines  possessed  advanced  medical 
knowledge,  making  use  of  a magnificent  flora,  full  today  of  secrets  to 
us.  They  knew  how  to  reduce  luxation  effectively,  and  employed  fixa- 
tion to  consolidate  fractures,  sometimes  having  recourse  in  both  cases 
to  kneading  (massage);  they  knew  the  dangers  of  free  exposure  of 
wounds  to  the  air,  curing  these  very  thoroughly;  they  could  easily  dis 
tinguisli  syphilis,  rheumatism,  ague,  fevers,  cerebral  disturbance,  men- 
tal aberration,  etc.  Fragments  of  flint  sharpened  to  a point  were  used 
for  bleeding  and  excising  pterygiums,  and  the  same  sharpened  on  the 

11 


12 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


edge  for  cutting  tbe  umbilical  cord.  Lastly,  they  possessed  a perfect 
process  of  mummification.  It  does  not  therefore  seem  strange,  surgical 
science  being  so  advanced  in  prehistoric  Peru,  that  on  the  presentation 
of  a broken  skull  they  should  attempt  first  to  extract  the  fragments  of 
bone,  to  raise  and  draw  out  successively  the  sunken  plates,  to  adjust 
the  points,  and,  in  a word,  with  their  primitive  instruments,  as  primi- 
tive as  those  of  ancient  Greece  and  Persia,  to  accomplish  the  linear 
readjustment  of  the  edges  of  the  fracture,  forming  a quadrangular  or 
polygonal  orifice.  After  this  they  could  easily  make  the  orifice  circular 
or  ellipsoidal,  etc,  by  means  of  strong  chisels  or  estiletes  of  copper, 
silver,  gold,  or  champi  (a  mixture  of  gold,  silver,  and  copper,  the  only 
metals  known  to  them);  also  an  instrument  called  tumi , which  con- 
sisted of  a blade,  straight  or  curved  like  a crescent,  edged  and  fur- 
nished with  a short  central  haft  in  the  form  of  a T,  together  with 
knives  and  lances  of  obsidian. 

It  would  be  an  extensive  undertaking  to  attempt  an  analysis  of  this 
subject,  and,  indeed,  the  last  works  of  Fletcher,  Mantegazza,  Mason, 
Wyman,  and  Munro  have  saved  me  the  task. 

How,  at  first  sight,  or  by  examination  with  the  lens,  it  is  possible  to 
distinguish  cranial  perforations  due  to  a pathologic  operation  from 
those  which  have  been  made  artificially.  The  difference  is  obvious  and 
very  clear.  But  it  has  been  supposed  that  when  they  were  not  patho- 
logic perforations  they  were  post-mortem  operations.  I repeat,  it  is  not 
difficult  to  know  whether  the  bone  has  been  separated  while  the  indi- 
vidual was  living  and  whether  he  survived  the  operation ; the  length  of 
time  could  even  be  determined  approximately.  There  are  histologic 
features  which  a lens  discloses  and  which  will  prove  without  a shadow 
of  doubt  the  survival  of  the  individual.  Moreover,  the  exaggerated 
veneration  of  the  ancient  Peruvians  for  their  dead  completely  disproves 
the  supposition,  which  has  been  advanced  in  regard  to  some  other 
countries  or  peoples,  that  trephining  was  performed  only  for  the  pur- 
pose of  procuring  amulets  consisting  of  segments  of  bone  extracted 
after  death  from  persons  noted  for  valor,  intelligence,  or  virtue.  This 
profanation,  if  we  may  so  call  it,  of  the  bodies  of  the  dead  was  impossi- 
ble in  ancient  Peru,  and  this  fact  is  proved,  since  to  this  day  there  has 
never  been  found  any  fragment  of  human  bone  which  could  have  been 
used  as  an  amulet. 

While  forming  my  collection  of  ancient  crania,  seeking  them  in  the 
various  provinces  of  Peru,  I have  succeeded  in  making  the  collection 
of  trephined  crania  illustrated  in  the  accompanying  plates.  I have  not 
attempted  for  the  present  to  make  a craniometric  study  of  them,  and 
take  into  consideration  only  the  different  forms  of  trephining  employed, 
some  of  which  have  not  been  recognized  up  to  the  present  time  in  pub- 
lications on  this  subject. 

The  well-known  cranium  of  Squier  was  found  in  the  valley  of  Yucay, 
near  Cuzco,  and  in  the  districts  adjoining  this  city,  the  metropolis  of  the 
ancient  Inca  empire,  were  found  those  numbered  7,  10,  12, 13,  and  18  in 


MUNIZ— MC  GEE] 


SUMMARY  STATEMENT 


13 


tbe  accompanying  description,  which  demonstrate  the  fact  that  in  these 
localities  trephining  was  not  exclusively  of  the  square  form,  but  that 
other  forms  also  were  employed. 

In  the  environs  of  Lima,  more  than  a thousand  miles  from  Cuzco, 
I discovered  crania  1,  2,  4,  5,  6,  8,  9,  14,  15,  16,  and  19,  within  a radius 
of  60  miles,  in  the  province  of  Huarochiri,  which  is  covered  with 
pre-Columbian  ruins. 

The  cranium  numbered  17  was  discovered  in  Tarma,  in  the  central 
part  of  Peru;  cranium  11  in  the  important  ruins  of  Pachacamac  in  the 
neighborhood  of  the  ocean,  15  miles  south  of  Lima.  Cranium  3 was 
found  in  the  ruins  of  Cauete. 

I should  observe  that  up  to  the  present  time  no  trephined  crania  have 
been  discovered  at  the  famous  necropolis  of  Ancon. 

All  these  skulls,  some  taken  from  caves,  pertain  to  a period  at  least 
two  hundred  years  anterior  to  the  discovery  by  Columbus. 

Resume 

1.  Trephining  as  a surgical  operation  was  employed  in  pre-Columbian 
Peru  in  various  pueblos  and  at  divers  latitudes. 

2.  Different  methods  of  operation  were  employed  as  the  segments 
extracted  were  of  different  shapes — square,  polygonal,  circular,  oval,  etc. 

3.  There  are  found  crania  which  show  that  the  individual  succumbed 
immediately  or  a short  time  after  the  completion  of  the  operation; 
others  are  found  which  indisputably  prove  the  survival  of  the  person 
subjected  to  the  operation. 

4.  It  is  almost  impossible  to  accept  for  ancient  Peru  the  idea  of  post- 
mortem trephining,  the  numerous  other  examples  of  cranial  perfora- 
tion being  probably  of  pathologic  origin. 


DESCRIPTION  AND  DISCUSSION  OF  THE  PERUVIAN 

CRANIA 


(W  .T  M.) 

THE  COLLECTION 

The  Muniz  collection  comprises  19  trephined  crania  out  of  a little 
over  1,000  specimens;  i.  e.,  almost  exactly  2 percent  of  the  crania  of 
the  collection  were  trephined.  Neglecting  a few  doubtful  cases  of 
repetition,  three  specimens  display  two  and  a third  three  distinct  opera- 
tions performed  at  different  periods  and  generally  on  different  parts  of 
the  cranium.  There  are  thus  twenty-four  clear  cases  of  trephining  out 
of  1,000  specimens,  or  a percentage  of  about  2.5. 

Two  of  the  crania  are  fragmentary;  the  other  17  nearly  or  quite 
entire.  Four  were  mummified  so  completely  that  the  desiccated  soft 
tissue  remains,  despite  accidents  of  exhumation  and  transportation; 
most  of  the  others  were  mummified  also,  though  the  tissues  have  now 
disappeared ; in  two  or  three  cases  the  bone  was  bleached,  and  in  two 
others  deeply  corroded,  when  found.  Most  of  the  thousand  skeletons, 
including  those  yielding  the  trephined  crania,  were  exhumed  from  light 
and  dry  sandy,  and  often  nitrous,  soil;  others  were  found  in  caves  and 
rock  shelters  or  on  the  surface  of  the  ground. 

Classed  geographically,  eleven  of  the  trephined  specimens  were  found 
in  the  province  of  Huarochiri,  chiefly  in  the  environs  of  Lima;  one 
specimen  was  found  in  Tarma,  another  in  Pachacamac,  not  far  from 
Lima,  and  still  another  in  the  province  of  Canete;  these  fourteen  speci- 
mens representing  western  central  Peru  and  the  more  arid  piedmont 
and  coastal  region.  Five  specimens  were  found  in  the  vicinity  of 
Cuzco,  in  the  southeastern  and  highly  mountainous  part  of  the  country. 

Arranged  in  the  order  of  description,  which  in  the  main  is  that  sug- 
gested by  character  of  operation,  the  crania  are  as  follows: 

1.  Semimummified  cranium  from  Huarochiri;  operation  by  rectilinear 
incision  (plates  i,  ii). 

2.  Semimummified  cranium  from  Huarochiri;  operation  by  rectilinear 
incision  (plates  iv,  v). 

3.  Weathered  cranium  from  Canete;  operation  by  rectilinear  incision 
(plates  vi,  vii). 

4.  Bleached  cranium  from  Huarochiri;  operation  by  compound  recti- 
linear incision  (plates  viii,  ix). 

14 


MUNIZ— MC  GEE] 


CHARACTER  OF  THE  CRANIA 


15 


5.  Semimumnrilied  cranium  from  Huarocliiri ; operation  by  multiple 
rectilinear  incision  (plates  x,  xi). 

6.  Fragmentary  cranium  from  Huarocliiri ; operation  by  curvilinear 
incision  (plate  xn). 

7.  Bleached  cranium  from  Cuzco;  two  operations  by  curvilinear  inci- 
sion (plates  xiii— xv). 

8.  Fragmentary  cranium  from  Huarocbiri;  operation  by  circular  inci- 
sion (plate  xvi). 

9.  Slightly  bleached  cranium  from  Huarocliiri;  operation  by  curvi- 
linear incision  and  rasping  dilates  xvn,  xviii). 

10.  Ocher-stained  cranium  from  Cuzco ; operation  by  rasping  or  scrap- 
ing (plates  xix,  xx). 

11.  Bleached  (distorted)  cranium  from  Pachacamac;  operation  by 
curvilinear  incision  and  rasping  (plates  xxi,  xxn). 

12.  Semimummilied  cranium  from  Cuzco;  two  operations,  by  curvi- 
linear incision  and  scraping,  respectively  (plates  xxiii,  xxiv). 

13.  Weathered  cranium  from  Cuzco;  two  operations,  by(?)  curvi- 
linear incision  and  rasping  (plate  xxv). 

14.  Mummified  cranium  from  Huarocliiri;  unfinished  operation  by 
compound  incision  (plates  xxvm,  xxix). 

15.  Mummified  cranium  from  Huarocbiri;  unfinished  operation  by 
compound  incision  and  elevation  (plates  xxx-xxxii). 

16.  Mummified  cranium  from  Huarocbiri;  unfinished  operations,  by 
rectilinear  incision  and  by  rasping  (plates  xxxiii,  xxxiv). 

17.  Mummified  cranium  from  Tarma;  operation  by  rasping,  with 
incomplete  operations  by  incision  (plates  xxxv,  xxxvi). 

18.  Semimummified  cranium  from  Cuzco;  three  operations,  by(?) 
curvilinear  incision  and  rasping  (plates  xxxvii,  xxxviii). 

19.  Semimummified  cranium  from  Huarocbiri;  operation  by  incision 
and  rasping,  supplemented  by  plate  (plates  xxxix,  xl). 

The  crania  are  represented  on  the  plates  indicated  by  photo- 
mechanical (half-tone)  reproductions  from  photographs,  mostly  by  Hil- 
lers, with  a few  by  Dinwiddle,  on  a scale  reduced  to  two-thirds  linear  of 
the  natural  size. 

TREPHINING  IN  GENERAL 
DISTRIBUTION 

Trephining  is  a fairly  common  operation  in  modern  surgery.  Essen- 
tially it  consists  in  the  removal  of  a small  section  from  one  of  the  bones 
of  the  skull,  usually  in  the  form  of  a circular  button  or  rondelle.  Ordi- 
narily the  operation  is  performed  by  means  of  a trephine,  or  annular 
saw,  supplemented  by  a few  other  instruments  of  simple  character, 
including  elevators,  stout  forceps,  etc,  together  with  the  usual  appli- 
ances for  making  and  closing  the  attendant  incisions  in  the  scalp.  In 
some  cases  the  button  is  restored,  either  entire  or  broken  up;  in  other 


16 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


cases  it  is  replaced  by  a plate  of  silver  or  other  substance;  sometimes 
the  aperture  is  left  and  covered  only  by  the  scalp. 

The  operation  is  employed  in  certain  cases  of  depressed  fracture  or 
other  traumatic  lesions  of  the  cranium,  and  in  cases  of  intra-cranial 
tumors  or  suppuration ; it  is  also  employed  for  epilepsy,  and  more  rarely 
as  a prophylactic,  or  to  gain  access  to  the  intra-cranial  tissues  for  local 
treatment. 

By  most  practitioners  trephining  is  regarded  as  a serious  or  even  des- 
perate operation,  and  is  resorted  to  only  in  grave  cases.  According  to 
Bluhm’s  statistics,  covering  nearly  1,000  cases,  the  mortality  exceeds 
50  percent,  most  of  the  cases  being  of  course  complicated  by  the  origi- 
nal lesion.  The  risk  is  better  determined  from  the  operations  for  epi- 
lepsy without  antecedent  traumatic  conditions;  of  these  cases  1G  out 
of  72  collected  by  Billings  and  28  out  of  145  collected  by  Echeverria, 
or  a mean  of  20  percent,  proved  fatal,  though  some  practitioners,  using 
special  precaution  against  sepsis  and  avoidable  injury  to  bone  and  tis- 
sues, have  obtained  better  results,  one  operator  recording  a mortality 
so  low  as  1 out  of  30  cases. 

Trephining  is  occasionally  employed  in  the  treatment  of  disorders 
among  domestic  animals,  though  not  so  much  by  trained  veterinarians 
as  by  rude  herdsmen  possessing  little  knowledge  of  anatomy  and  less 
of  etiology,  and  imbued  with  fantastic  notions  concerning  the  effect  of 
the  operation ; e.  g.,  it  is  performed  on  sheep  aud  swine  with  the  notion 
of  rupturing  a supposed  bubble  or  bladder  beneath  the  skull,  or 
extracting  a grub  or  worm  from  the  brain  of  the  animal,  and  thus 
relieving  a mysterious  disorder.  In  such  cases  the  operation  is  com- 
monly performed  in  rude  fashion,  perhaps  with  carpenter’s  tools,  a 
chisel  and  mallet,  and  even  an  auger  being  sometimes  employed.  Not 
infrequently  the  animal  survives,  and  iii  some  cases  appears  to  be 
benefited. 

Among  certain  primitive  peoples  trephining  is  practiced,  sometimes 
with  astonishing  frequency.  The  Kabyle,  a nomadic  and  essentially 
autochthonous  tribe  of  Algeria,  resort  to  trephining  not  ouly  in  trau- 
matic lesions  of  the  head,  but  for  neuralgia,  vertigo,  and  various  other 
disorders.  The  operation  is  performed  rudely,  either  with  such  tools 
or  implements  as  may  chance  to  be  at  hand,  or  with  crude  metallic 
saws,  perforators,  and  elevators  designed  for  the  purpose.1  Ordinarily 
the  aperture,  which  is  frequently  large  aud  usually  irregular,  is  closed 
by  a plate,  though  it  is  often  left  open  and  covered  only  by  the  scalp. 
The  frequency  of  the  operation  indicates  that  the  mortality  can  not  be 
very  high,  and  one  observer  saw  men  who  had  survived  five  or  six 
operations  at  different  periods  aud  for  different  injuries.  The  operator 
is  a hereditary  shaman  or  priest,  and  the  operation  is,  at  least  in  part, 
thaumaturgic;  the  methods  are  clumsy,  painful,  and  tedious,  yet  the 
victim  glories  in  his  undemonstrative  endurance  of  the  ordeal. 


1 “ On  Prehistoric  Trephining  and  Cranial  Amulets,"  by  Dr  Robert  Fletcher,  in  Contributions  to 
North  American  Ethnology,  vol.  v,  1882,  p.  25  et  seq. 


MUNIZ — MC  GEE] 


METHODS  OF  TREPHINING 


17 


Trephining  is  well  known  among  certain  savages.  For  example,  the 
South  Sea  islanders  were,  when  first  seen  by  white  men,  acquainted  with 
the  operation,  which  was  performed  by  scraping  with  a flint  implement, 
a shark  tooth,  or  (after  contact  with  the  whites)  a piece  of  broken  glass. 
The  aperture  was  commonly  covered  with  a carefully  prepared  piece  of 
cocoanut  shell.  The  purpose  was  to  relieve  headache,  neuralgia,  ver- 
tigo, and  the  like,  yet  the  operation  appears  to  have  been  essentially 
thaumaturgic.  The  mortality  has  been  estimated  at  50  percent,  yet  the 
treatment  is  said  to  have  been  so  common  in  early  days  that  most  of  the 
male  adults  had  undergone  one  or  more  operations. 

Even  in  prehistoric  times  trephining  was  not  uncommon  in  various 
parts  of  the  world,  as  has  been  shown  by  Broca,  Prunieres,  and  others 
in  Europe,  and  by  Fletcher  and  some  other  investigators  in  this  country. 
While  there  are  indications  that  the  motives  varied,  satisfactory  evi- 
dence has  been  adduced  to  show  that  prehistoric  trephining,  particu- 
larly in  Europe,  was  essentially  thaumaturgic,  and  that  in  many  cases 
the  operation  was  post-mortem  and  designed  to  yield  rondelles  for  use 
as  amulets.  The  instruments  used  in  removing  the  rondelle  were  those 
pertaining  to  the  current  cultural  stage. 

Thus  the  distribution  of  trephining  with  respect  to  time,  territory 
and  culture- grade  shows  that  the  operation  is  common  to  several 
countries  and  to  all  stages  in  the  development  of  mankind  from  the 
unwritten  past  to  the  present  and  from  savagery  to  civilization,  and  that 
the  methods  and  motives  have  varied  widely  with  cultural  progress. 

CLASSIFICATION 

The  operation  of  trephining,  as  performed  by  different  peoples  in  the 
several  culture  stages,  may  be  regarded  from  different  points  of  view, 
and  so  classed  in  different  ways: 

Classed  with  respect  to  period,  the  operation  may  be  considered  as 
(1)  prehistoric,  and  (2)  modern. 

Classed  with  respect  to  the  methods  employed,  trephining  may  be  con- 
sidered as  (1) primitive  and  (2)  specialized.  Primitive  trephining  may  be 
defined  as  that  performed  by  means  of  implements  or  tools  either  undif- 
ferentiated or  specialized  for  other  functions;  specialized  trephining 
maybe  defined  as  that  performed  by  means  of  instruments  designed  and 
made  for  the  purpose.  Under  these  definitions,  primitive  trephining' 
comprises  allthe  known  prehistoric  operations,  the  operations  performed 
by  the  South  Sea  islanders,  and  the  rude,  rural  trephining  of  domestic 
animals;  while  specialized  trephining  embraces  not  only  the  highly 
developed  operations  of  modern  surgery,  but  also  such  crude  operations 
as  those  of  the  Kabyle,  when  performed  by  trained  shamans  with 
special  apparatus.  These  primary  classes  are  so  broad  as  to  be  sus- 
ceptible of  subdivision.  Accordingly,  primitive  trephining  may  be 
considered  as  (a)  archaic,  or  that  performed  anciently  or  without 
knowledge  or  use  of  metal,  including  the  prehistoric  operations  and 
16  eth 2 


18 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


those  of  the  South  Sea  islanders,  and  (b)  neoteric , or  that  performed 
moderidy,  or  by  means  of  metal,  including  the  skilless  operations  on 
domestic  animals.  Commonly,  or  always,  neoteric  trephining  is  accul- 
tural,  and  represents  the  engrafting  of  a higher  technology  on  the 
stock  of  a lower  sophiology.  Specialized  trephining  may  in  like  man- 
ner be  subdivided  into  two  classes — (a)  rude,  or  that  performed  in  a 
simple  and  barbarous  manner  by  untrained  or  sliamanistic  operators 
without  knowledge  of  physiology,  as  among  the  Kabyle;  and  (b)  refined , 
or  that  performed  skillfully  and  intelligently,  as  by  civilized  surgeons. 

Classed  with  respect  to  motive  or  purpose,  trephining  may  be  consid- 
ered as  (1)  thaumaturgic  and  (2)  therapeutic.  Thaumaturgic  trephining 
is  presumed  to  act  in  an  occult  or  mystical  way,  either  for  the  good  of 
the  sufferer  or  for  the  benefit  of  the  operator  or  others;  it  may  be  styled 
(a)  vicar  ion*,  when  designed  to  benefit  the  operator  or  others,  and  ( b ) 
sortilegic , when  practiced  in  the  interest  of  the  sufferer.  Vicarious 
trephining  as  thus  defined  is  commonly  (so  far  as  known  through 
observation,  always)  post-mortem,  while  sortilegic  trephining  must  be 
essentially  ante  mortem.  Under  these  definitions  the  prehistoric  tre- 
phining recorded  by  Broca,  Fletcher,  and  others  must  have  been 
vicarious,  at  least  so  far  as  post-mortem ; while  the  operations  exem- 
plified among  the  South  Sea  islanders,  and  perhaps  also  among  the 
Kabyle,  are  sortilegic,  and  thus  occupy  a well-marked  early  stage  in 
the  development  of  medical  practice.  Therapeutic  trephining  may  be 
defined  as  that  employed  intentionally  and  intelligently,  and  without 
regard  to  the  supernatural,  to  relieve  a disorder;  and  it  may  be  either 
(a)  empiric , when  it  is  not,  or  (b)  scientific , when  it  is,  guided  by 
knowledge  of  physiology  or  etiology,  one  or  both. 

Trephining  may  be  classed  also  by  the  culture-grade  of  the  people 
practicing  it,  as  (1)  savage , (2)  barbaric , and  (3)  civilized ; or,  more  con- 
veniently,as  (1)  uncivilized  and  (2)  civilized.  This  classification  crosses, 
and  in  a measure  corrects,  the  grouping  by  period,  since  it  emphasizes 
the  persistence  in  some  countries  of  characteristics  which  in  other 
countries  existed  only  during  the  prehistoric  past. 

These  classes  are  defined  from  the  standpoint  of  anthropology  rather 
than  from  that  of  surgery  or  medicine  in  general;  yet  their  recognition 
seems  essential  to  comprehension  of  the  origin  and  development  of  one 
of  the  most  remarkable  among  the  triumphs  of  modern  surgery.  Their 
significance  is  such  as  to  warrant  juxtaposition  and  careful  comparison : 


Period  Method 

-vi  i o ■ t i Refined 

Modern  Specialized..  - , 

1 I Rude 

r>  , • , • -r,  . . ( Neoteric 

Prehistoric  Primitive  ...  - A , • 

1 Archaic 


Motive 


Therapeutic. .. 
Thaumaturgic. 


i Scientific 
) Empiric 
J Sortilegic 
( Vicarious 


Culture-tirade 

Civilized 


Uncivilized 


On  comparing  the  method  classes  with  the  periods  and  culture-grades, 
it  is  found  that  archaic  trephining  was  chiefly  prehistoric  and  exclu- 
sively eodemotic,  but  that  neoteric  trephining  persists,  at  least  ves 
tigially,  among  backward  representatives  of  civilized  peoples;  yet  that 


MUNIZ — MC  GEE] 


ORIGIN  OF  TREPHINING 


19 


in  general  primitive  metliocl  coincides  with  uncivilized  culture.  In  like 
manner  it  is  found  that  rude  trephining,  as  displayed  typically  among 
the  Kabyle,  is  distinctively  above  that  of  the  prehistoric  period  and 
demonstrates  a differentiation  of  labor  and  a social  organization  tran- 
scending that  of  simple  kinship,  so  that  it  falls  logically  into  the  civilized 
stage,  while  refined  trephining  belongs  to  advanced  culture. 

When  the  motive  classes  are  compared  with  the  others,  it  is  found 
that  vicarious  trephining  is  wholly  prehistoric  so  far  as  present  knowl- 
edge extends,  and  that  both  the  vicarious  and  sortilegic  operations  are 
essentially  uncivilized,  though  the  sortilegic  practice  is  found  in  modern 
times  among  peoples  of  the  lower  culture  status.  So,  too,  the  vicarious 
operation  was  performed  by  the  archaic  method,  while  the  sortilegic 
operation  is  essentially  neoteric,  though  the  thaumaturgic  motive  out- 
lived the  primitive  method  so  far  as  partially  to  control  the  rude  opera- 
tions of  the  Kabyle  class.  Similarly  the  empiric  operation  is  character- 
istically rude,  and  in  general  pertains  to  the  modern  period  and  marks 
the  transition  from  uncivilized  to  higher  culture,  while  scientific  tre- 
phining is  modern  in  period,  refined  in  method,  and  civilized  or  enlight- 
ened in  culture-grade. 

These  coincidences  are  too  many  and  too  close  to  be  fortuitous,  and 
the  classes  can  be  regarded  only  as  indices  to  the  progressive  develop- 
ment, if  not  to  the  origin,  of  trephining  and  of  so  much  of  surgery  as  is 
involved  therewith. 


ORIGIN  AND  DEVELOPMENT 

Trephining  is  one  of  the  boldest  operations  of  modern  surgery,  rival- 
ing plastic  surgery  and  cceliotomy  as  a revelation  of  the  ambition  and 
ability  of  the  trained  practitioner  to  explore,  modify,  re-create,  and  in 
every  way  shape  to  his  liking  even  the  most  delicate  parts  of  living 
organisms.  Yet,  remarkable  as  is  the  modern  achievement  of  special- 
ized trephining,  it  pales  before  the  marvel  of  primitive  trephining,  which 
is  proved  by  indisputable,  though  all  but  incredible,  evidence  to  have 
been  performed  habitually  and  successfully  by  barbaric  and  even  savage 
peoples  during  remote  ages.  The  archeologic  and  ethnologic  records 
prove  not  merely  the  occurrence  of  the  operations  in  prehistoric  times 
and  among  various  tribes,  but  indicate  that  among  certain  primitive 
peoples  the  operation  was  better  known  than  in  modern  civilization, 
more  common  even  than  in  modern  hospitals.  Among  the  Kabyle,  stu- 
dents are  impressed  by  the  number  of  individuals  who  have  undergone 
the  operation;  among  the  South  Sea  islanders,  the  observers  report 
that  nearly  every  male  adult  has  been  trephined  once  or  oftener;  and 
among  the  prehistoric  ossuaries  of  southern  Europe  the  proportion  of 
trephined  crania  is  strikingly  large.  Perhaps  the  best  evidence  as  to 
the  frequency  of  the  operation  among  the  primitive  people  of  the  world 
is  that  afforded  by  the  Muniz  collection,  with  its  ratio  of  2 percent 
of  trephined  individuals  and  2.5  percent  of  operations  to  entire 


20 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


crania — a ratio  probably  higher  than  that  of  any  modern  military  hos- 
pital, and  scores  or  hundreds  of  times  higher  than  that  of  the  average 
cemetery  of  civilization.  Most  of  the  bolder  operations  of  recent  sur- 
gery are  of  modern  invention,  many  of  them  reflecting  (in  successful 
practice  at  least)  the  career  of  a leader  still  living,  Sir  Joseph  Lister ; but 
trephining  boasts  an  origin  so  remote,  a lineage  so  long,  an  ancestry  so 
eminent,  as  to  claim  a special  place  among  the  medical  arts.  It  would 
be  difficult  to  find  a more  striking  illustration  of  the  persistence  of  a 
remarkable  custom  throughout  the  stages  of  cultural  development  than 
that  exemplified  in  trephining,  and  the  example  is  of  the  first  impor- 
tance in  illustrating  the  development  of  the  healing  art  with  which  it  is 
connected. 

Reviewing  the  relations  epitomized  in  the  table,  it  may  be  noted  par- 
ticularly that  the  practice  of  trephining  has  not  only  outlived  the  com- 
plete transformation  in  technology  which  accompanied  the  passage  from 
stone  to  metal,  but  has  survived  all  of  the  most  profound  intellectual 
revolutions  in  the  history  of  mankind.  As  a corollary  of  this  striking 
proposition  (which  is  fully  established  by  the  facts  summarized  in  the 
table),  it  may  be  noted  particularly,  also,  that  trephining  was  not  orig- 
inally a curative  treatment;  indeed,  the  early  practitioners  had  no  con- 
ception of  real  curative  or  restorative  treatment,  no  glimmering  of 
physiologic  or  etiologic  knowledge,  no  idea  of  relation  between  health 
and  disease,  no  definite  notious  concerning  the  conditions  of  life  and 
the  causes  of  death.  As  a scholium  to  this  corollary,  it  may  be  par- 
ticularly noted,  finally,  that  the  practice  of  trephining  has  survived 
transformation  in  motive  and  has  persisted  ouly  through  the  gathering 
of  new  motives  as  knowledge  has  progressively  grown  up. 

Thus  the  history  of  trephining  is  complex,  and  it  is  not  easy,  from  the 
standpoint  of  modern  knowledge,  to  perceive  how  or  why  the  practice 
was  pursued  in  any  generation  or  in  any  succession  of  generations 
before  the  development  of  scientific  motives  and  refined  methods.  True, 
it  may  be  stated  as  a general  law — the  verity  of  which  is  not  generally 
recognized,  though  it  may  confidently  be  affirmed — that,  save  sometimes 
in  the  modern  stage  of  invention,  men  learn  how  and  why  they  act  only 
by  acting,  so  that  the  action  precedes  its  own  explanation;  yet  even 
this  law  does  not  fully  elucidate  the  origin  of  a peculiar,  not  to  say 
monstrous,  course  of  action,  nor  does  it  clearly  indicate  how  such  an 
operation,  visibly  accompanied  by  great  suffering  and  often  attended  by 
loss  of  life,  could  have  originated  intelligently  or  could  have  persisted 
even  if  it  originated  accidentally.  Manifestly  the  chief  difficulty  in  the 
way  of  explaining  the  origin  of  trephining  grows  out  of  the  fact  that 
the  operation  was  discovered  and  was  long  practiced  before  the  motives 
actuating  enlightened  men  were  developed;  and  it  follows  that  search 
for  the  origin  of  the  operation  can  be  hopefully  conducted  only  in  the 
light  of  knowledge  of  the  motives  of  primitive  men.  Fortunately  the 
way  in  which  barbaric  and  savage  people  think  is  coming  to  be  under- 
stood; and  the  light  thus  given  illumines  fairly,  though  at  some  points 
faintly,  the  wonderful  course  of  development  of  the  art  of  trephination. 


MUNIZ — MC  GEE] 


DEVELOPMENT  OF  BELIEFS 


21 


Primitive  men  are  mystics.  In  the  earliest  stage  in  the  development 
of  belief,  all  objects,  bnt  especially  the  rare  and  unfamiliar,  are  supposed 
to  be  imbued  with  mysterious  attributes  and  powers  which  are  exer- 
cised capriciously  for  the  good  or  the  evil  of  the  egoistic  and  egotistic 
thinker — for  magnification  of  the  ego  is  the  leading  characteristic  of 
primitive  thought.  Thus,  in  this  stage,  primitive  man  considers  himself 
surrounded  by  mysterious  potencies,  beneficent  and  maleficent,  whose 
favor  is  sought  by  propitiation,  which  commonly  takes  the  form  of 
fetich- worship,  amulet- wearing,  and  oblation.  As  this  stage  in  the 
development  of  belief  advances,  the  mysterious  potencies  are  segregated ; 
some  are  regarded  as  more  beneficent  or  maleficent  than  others;  and 
the  supposed  actions  of  the  imaginary  powers  gradually  come  to  be  held 
as  less  capricious,  more  uniform  or  regular,  than  at  the  outset.  In  the 
second  stage  of  the  development  of  belief,  the  mysterious  potencies  are 
still  further  segregated  and  ascribed  mainly  to  animate  or  self-moving 
things,  and  in  time  animals,  particularly  the  strong,  the  swift,  and  the 
venomous,  are  deified.  In  this  stage  the  veneration  of  animal  totems, 
the  taboo,  and  other  curious  customs  develop,  while  amulet-wearing  and 
oblation  persist.  In  this  stage,  too,  inimical  men  and  women,  both  alien 
and  intern,  are  assumed  to  possess  mystical  powers,  and  witchcraft  and 
a peculiar  fear  of  and  veneration  for  members  and  fragments  of  the 
human  body  arise;  thus  incantation  and  sorcery  through  nail-parings, 
hair-combings,  and  other  parts  of  the  person  (the  synecdochic  magic  of 
Mason),  and  the  wearing  of  scalps  or  fingers  or  teeth  of  slain  enemies, 
first  as  charms  and  later  as  trophies,  grow  up  as  features  in  formal  or 
ceremonial  propitiation  of  mysterious  powers.  As  this  stage  advances, 
the  deific  animals  are  presumed  to  possess  supernatural  forms  as  well 
as  powers,  and  thus  the  age  of  dragons  and  chimeras  and  goblins  and 
molochs  is  introduced.  In  the  third  stage  in  the  development  of  belief, 
the  mysterious  potencies  are  so  far  classified  and  arranged  as  to  corre- 
spond with  the  powers  of  nature — the  action  of  sun  and  moon  and  stars, 
of  thunder  and  lightning,  of  winds,  of  storm-waves  and  torrents,  of  the 
cold  of  the  north  and  the  winter,  etc — and  these  are  personified  first  as 
beast-gods  and  later  as  anthropomorphic  deities.  In  this  stage,  incan- 
tation and  sorcery  gradually  become  incongruous  with  the  developing 
belief,  and  either  disappear  or  (under  a curious  law,  exemplified  in 
biology  as  well  as  demology,  which  maybe  called  the  Law  of  monstrosi- 
ties)1 pass  into  divination  or  sortilege,  which  leads  into  necromancy  or 
jugglery,  such  as  culminates  among  the  fakirs  of  India,  or  grow  into 

‘As  is  well  known,  when  deep-sea  dslies  are  traced  downward  into  the  abysmal  depths  where  the 
light  is  faint,  the  eyes  of  some  species  disappear,  while  those  of  others  are  abnormally  developed ; it  is 
also  well  known  that  when  a flora  is  traced  into  the  desert,  some  plants  become  dwarfed  and  shrunken 
with  the  diminishing  moisture,  while  others  develop  tumid  and  pulpy  trunks  to  fit  themselves  to  the 
ehanged  conditions.  In  like  manner,  when  a belief  outlasts  the  conditions  under  which  it  was  devel- 
oped, it  may  he  either  abandoned  or  modified ; in  the  latter  case  the  modification  soon  becomes  incon- 
gruous with  the  ever-changing  conditions,  when  it  is  again  necessary  either  to  abandon  or  modify ; and 
thus  beliefs  tend  to  develop  into  persistent  extravagancies  with  respect  to  both  concept  and  ceremo- 
nial. It  is  needless  for  the  present  to  trace  this  tendency  in  detail  or  to  enumerate  the  many  striking 
illustrations  of  the  law. 


22 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


trial  by  ordeal,  as  among  our  own  ancestors;  yet  invocation  and  sacri- 
fice persist,  and  amulets  retain  their  hold.  By  Powell  these  stages  iu 
the  development  of  belief  are  respectively  denominated  liecastotheism, 
zootheism,  and  physitheism.1  Some  knowledge  of  these  stages  in  the 
development  of  belief  is  requisite  for  comprehension  of  the  motives 
and  mental  operations  of  primitive  men. 

There  is  a human  trait  characteristic  of  all  stages  of  development, 
and  especially  prominent  iu  the  earlier  stages,  which  bears  directly 
on  the  discussion  of  the  motives  of  early  men;  it  results  in  what  may 
be  called  the  Law  of  the  development  of  fable.  The  mind  is  so  consti- 
tuted as  to  demand  explanations;  at  the  same  time  it  is  prone  to  offer 
and  accept  the  chaff  of  hypotheses  in  lien  of  the  grain  of  full  under- 
standing; and  these  tendencies  are  specially  prominent  in  the  com- 
munion of  children  and  adults.  A pertinent  illustration  of  the  trait  is 
the  development  of  belief  in  shades  of  the  departed,  which  is,  in  many 
respects,  parallel  to  the  recognition  of  mysterious  potencies  or  doubles 
of  things  in  hecastotheism.  The  hunter  dies;  the  sages  of  the  clan  or 
tribe,  warned  by  experience,  forestall  dispute  concerning  future  owner- 
ship of  the  favorite  weapon  by  burying  it  with  his  body.  The  children 
ask  why  the  weapon  was  buried,  aud  their  elders,  ignorant  of  the  real 
reason,  say  the  hunter  still  has  need  of  it;  so  the  children  are  strength- 
ened in  their  notion  of  mysterious  potencies,  and  think  of  the  hunter 
as  still  using  his  favorite  weapon  in  a mystical  hunting  ground.  But 
in  all  stages  of  development,  belief  luns  a close  race  against  cupidity, 
and  is  sometimes  distanced;  so  the  sages  learn  that  even  a buried 
weapon  may  be  a source  of  contention,  which  they  thenceforward  fore- 
stall by  breaking  or  burning  it.  Again  the  children  ask  why,  and  the 
ill-advised  elders  are  put  to  the  further  explanation  that  the  broken  or 
burned  weapon  is  none  the  less  serviceable  to  the  dead  hunter,  since  it 
is  thereby  changed  only  as  he  is  changed;  so  the  hypothesis  of  myste- 
rious shades  is  strengthened  and  extended  to  weapons,  and  eventually 
to  favorite  animals,  as  well  as  to  the  huntsmen  aud  their  consorts.  In 
time  the  easily  satisfied  children  become  the  sages  of  their  clan  or 
tribe,  and  lay  down  simple  yet  definite  laws  iu  accordance  with  their 
early  notions  concerning  shades.  They  are  unable  to  find  the  shadowy 
hunting  ground,  and  consequently  argue  that  it  must  be  a long  way 
off,  and  that  the  dead  hunter  must  needs  be  provisioned  against 
the  journey;  so  food  and  drink  are  buried  or  burned  with  the  dead, 
and  the  children  are  regaled  with  enriched  hypotheses;  and  through 
the  union  of  natural  affection,  belief,  and  ceremonial  the  lifeless  body 
becomes  a doubly  mysterious  and  sacred  thing,  and,  if  the  stage  of 
development  is  that  of  synecdochism,  a mysteriously  potent  thing. 
This  is  only  one  of  the  ways  in  which  the  primitive  (and  even  mod- 
ern) tendency  to  explain  by  half  knowledge  is  developed  into  motive- 
shaping  belief;  the  ways  are  legion. 


•The  subject  of  primitive  belief  is  developed  somewhat  more  fully  in  “The  Siouan  Indians,” 
Fifteenth  Annual  Report  of  the  Bureau  of  Ethnology,  for  1892-93,  (1897)  pp.  153-204. 


MUNIZ — MC  GEE] 


TREPHINING  AFFECTED  BY  BELIEFS 


23 


Understanding  primitive  motives  and  mental  traits,  and  the  modes  of 
thought  which  they  reflect,  it  is  not  difficult  to  discover  the  origin,  or  at 
least  a quite  early  stage  in  the  development,  of  post-mortem  trephining; 
and  it  is  possible  to  buttress  on  this  basis  a partly  hypothetic  bridge 
spanning  the  chasm  between  post-mortem  vicarious  operations  and 
ante-mortem  trephining,  both  thaumaturgic  and  therapeutic.  When, 
in  the  stage  of  amulet  wearing  and  synecdochism,  the  warring  tribes- 
man slew  an  enemy,  he  sometimes  mutilated  the  remains  and  even  ate  of 
the  heart,  not  only  in  savage  triumph,  but  mainly  in  order  that  he  might 
gain  the  courage  and  strength  of  his  quondam  opponent;  and  partly 
as  a trophy,  but  chiefly  as  a mystical  talisman  and  constant  invocation 
to  the  powers,  he  appended  the  scalp  to  his  spear  or  belt,  or  strung  the 
teeth  in  a necklace,  or  converted  the  erstwhile  powerful  hand  into  a 
gorget.  This  stage  and  custom  are  well  known  among  the  primitive 
peoples  of  the  earth.  Beaching  a little  way  into  the  unknown  from  this 
buttress  of  the  known,  it  is  easy  to  see  that,  save  perhaps  in  the  driest 
climates,  the  indecomposable  teeth  would  be  found  more  satisfactory 
talismans  than  the  decomposable  scalp  or  hand,  and  that,  through  nat- 
ural association,  the  durable  skull  lying  just  beneath  the  evanescent 
scalp  of  the  mutilated  body  might  easily  come  to  be  drawn  upon  for 
the  amulet  trophy.  This  inference  lies  close  to  established  fact,  since 
it  is  well  known  that  certain  primitive  tribes  preserve  the  entire  or 
mutilated  heads  of  enemies  slain  in  battle.  It  is  but  another  easy  step 
to  the  stage  in  which  one  or  more  pieces  of  the  skull  (for  in  synecdo- 
chism the  piece  carries  the  virtue  of  the  whole)  of  the  slain  enemy  were 
used  as  amulets,  either  as  supplementary  to  or  as  substitutes  for  the 
teeth.  Here  again  the  structure  of  explanation  rests  on  the  firm 
ground  of  established  fact,  as  revealed  through  study  of  the  prehistoric; 
for  it  is  well  known  that  post-mortem  trephining  was  extensively  prac- 
ticed in  certain  cases  during  prehistoric  times,  and  that  the  roudelles 
obtained  thereby  were  worn  and  treasured  after  the  manner  of  amulets. 
Thus,  in  this  stage,  trephining  must  have  been  performed  with  a defi- 
nite motive,  under  the  zootheistic  belief  that  the  slain  warrior  vicariously 
strengthened  his  slayer.  It  is  probable — nay,  certain,  as  archeologic 
record  indicates — that  the  grisly  custom  strengthened  through  exercise 
and  extended  to  the  taking  and  prizing  of  amulets  from  other  skulls 
than  those  of  enemies  slain  in  battle,  so  that  the  custom  matured  in  a 
cult  of  morbid  and  revolting  character,  in  which  the  growing  sacred- 
ness of  the  human  body  under  synecdochic  mysticism  played  an 
important  part. 

Here  a span  in  the  explanation-structure  fails,  yet  the  chasm  is  not 
too  broad  and  deep  for  easy  crossing  on  the  scaffolding  afforded  by 
study  of  primitive  ideation:  The  keynote  to  zootheism  is  the  animate 
power  or  self-motility  of  animals,  whereby  they  are  exalted  above  all  self- 
moveless things ; and  thus  to  the  zootheist,  dominated  by  synecdochism, 
the  talisman  taken  from  the  wounded  enemy,  while  still  living,  was 
immeasurably  more  potent  than  that  taken  from  the  dead  enemy;  and 


24 


PRIMITIVE  TREPHNING  IN  PERU 


[ETH.  ANN.  16 


so  it  must  have  been  that  the  well-known  ante-mortem  mutilation, 
which  on  the  one  hand  grew  into  the  scalping  of  wounded  warriors  and 
the  appalling  torture  found  among  the  American  Indians  as  well  as 
among  other  savages,  must  have  grown  on  the  other  hand  (when  ante- 
cedent conditions  were  favorable)  into  ante-mortem  trephining  of 
wounded  and  later  of  woundless  captives.  When  this  stage  was 
reached,  experience — which  taught  primitive  men  as  modern  men  are 
taught,  though  much  more  slowly — must  have  shown  that  sometimes 
the  sufferers  survived,  and  were  perhaps  even  improved.  Now,  if  the 
practice  were  continued  among  a given  people  into  that  part  of  the 
stage  of  physitheism  in  which  the  cult  of  kismet  prevails  (as  among  so 
many  people  in  the  upper  strata  of  uncivilized  culture,  including  the 
Kabyle,  if  not  the  South  Sea  islanders),  the  custom  of  trephining 
wounded  captives  would  almost  necessarily  grow  up,  with  the  idea  that 
a mystical  significance  attached  to  the  operation  as  a sort  of  ordeal;  the 
idea  might  be  that,  if  fate  so  willed,  the  captive  would  thereby  become 
the  more  perfectly  affiliated  with  the  captors,  while  if  Allah  decreed 
death  under  the  knife — so  mote  it  be.  There  is  but  one  short  step  more 
to  the  solid  ground  of  known  fact,  i.  e.,  the  gradual  extension  of  the  fatal- 
istic or  sortilegic operation  from  captives  to  others;  and  this  transition 
is  in  accord  with  known  methods  of  thought  among  primitive  folk 
belonging  to  that  stage  of  physitheism  or  incipient  psychotheism  in 
which  the  ordeal  was  developed;  for  it  was  quickly  perceived  among 
many  peoples  that  if  the  ordeal  was  beneficent  to  one  class  it  could  not 
be  devoid  of  good  when  extended  to  other  classes.  Here  again  the 
structure  of  explanation  rests  on  the  firm  ground  of  observation;  for 
the  typical  trephining  of  the  South  Sea  islanders,  and  in  large  measure 
the  typical  Kabyle  operation,  represent  the  general  sortilegic  stage  in 
the  development  of  trephining. 

The  spau  of  the  explanation-structure  extending  from  sortilege  to 
empiricism  is  long  but  well  supported;  for  while  the  transition  from 
purely  fatalistic  treatment  of  the  sick  to  empiric  treatment  of  disease 
was  slow  among  each  people,  its  course  has  been  well  observed.  Grad- 
ually the  mysticism,  the  belief  in  occult  power1,  waned;  gradually  the 
recognition  that  given  treatment  (howsoever  random)  was  followed  by 
fairly  uniform  results  waxed.  Thus  the  doctrine  of  signatures  grew 
into  simple  therapeutics;  thus  the  belief  in  blind  fate  grew  into  belief 
in  the  kingly  touch;  and  thus  dimly  realized  experience  of  the  uniform- 
ity of  cause  and  effect  made  medics  out  of  hermits  and  beldams  and 
chemists  out  of  alchemists,  and  in  time  made  nurses  and  neighborhood 
practitioners  out  of  sedate  and  observant  men  and  women.  With  the 
tedious  revolution  in  medicine  went  a slow  transformation  in  surgery, 
and  the  shamans  and  their  descendant  doctors  gradually  forgot  the 
ordeal  motive,  and  trephined  men  and  animals  in  desperate  cases  because 
their  teachers  had  done  so — and  were  they  not  wise  men? 

The  span  from  empiric  treatment  of  disease  to  scientific  medicine 
and  surgery  is  not  long,  and  is  covered  in  the  history  of  every  civilized 


MUNIZ — MC  GEE] 


DEVELOPMENT  OF  TREPHINING 


25 


country,  aud  indeed  by  the  range  of  current  thought  in  America  and 
Europe.  Practitioners,  like  other  men,  first  learn  how  and  then  learn 
why  to  act  through  action;  the  zealous  physician  scans  memory  and 
record  of  cases  in  the  effort  to  find  a treatment  which  gives  promise  of 
saving  his  patient;  he  can  not  forget  trephining,  for  the  records  are 
full  of  it,  his  clientele  remind  him  of  it,  and  his  rural  neighbor  per- 
chance practices  it  on  his  beast.  He  can  and  does  weigh  the  risk  as 
shown  by  the  results  of  empiric  practice;  he  can  and  does  consider  the 
physiologic  conditions  and  etiologic  bearings  of  the  operation;  and  in 
the  end  the  operation  is  performed  or  not,  as  the  best  judgment  of  prac- 
titioner or  consultation  may  decide.  Yet  in  every  case  the  decision 
is  based  largely  on  the  record,  and  the  treatment,  if  adopted  at  all,  is 
adopted  largely  if  not  mainly  by  reason  of  empiric  experience  rather 
than  by  reason  of  etiologic  considerations;  indeed,  the  layman  may 
well  question  whether  the  desperate  operation  of  trephining  (in  con- 
tradistinction from  simple  elevation  or  extraction  of  bony  fragments  in 
case  of  depressed  fracture)  would  have  been  introduced  before  plastic 
and  intestinal  surgery  had  it  not  come  down  from  the  prehistoric  past, 
a legacy  from  the  darkest  ages. 

In  this  way  the  genesis  and  development  of  one  of  the  most  remark- 
able features  of  medical  practice  may  be  traced  with  a fair  if  not  high 
degree  of  certainty.  The  explanation  seems  safe,  because  it  rests  on 
well-established  fact  at  many  points;  it  seems  just,  because  it  is  in  close 
accord  with  all  that  is  known  of  the  evolution  of  methods  and  motives 
among  men.  The  course  of  development  thus  traced  is  not  only  of 
interest  in  itself  and  in  its  bearings  on  the  trephining  of  Peru,  but  is  of 
much  significance  in  its  relation  to  the  development  of  other  branches 
of  surgery  and  medicine. 

It  remains  to  interpret  the  Muniz  collection  in  the  light  of  the  his- 
tory of  trephining  as  thus  outlined,  and  then  to  consider  the  facts 
revealed  in  this  collection  as  bearing  on  the  history. 

THE  CRANIA  IN  DETAIL 

Common  Features 

Collectively  the  crania  are  notably  small  and  variable  in  form,  as 
indicated  by  the  illustrations,  which  depict  different  aspects  on  a 
scale  of  two-thirds  linear.  With  one  possible  exception,  all  are  adult 
and  some  fully  mature,  as  indicated  by  the  condition  of  the  sutures. 
Considered  collectively  the  cranial  bones  are  remarkably  thick  and 
strong,  only  one  or  two  of  the  specimens  approaching  the  Caucasian 
normal  in  respect  to  thinness.  The  tendon  and  muscle  attachments 
are  notably  prominent,  rugose,  and  striated,  indicating  vigorous  phys- 
ical development.  In  several  cases  the  supernumerary  interparietals 
known  to  archeologists  as  “ Inca  bones”  are  found.  In  one  fully  adult 
specimen  the  metopie  suture  is  distinctly  preserved;  and  in  general 
the  sutures,  especially  the  lambdoid  and  the  posterior  portion  of  the 
sagittal,  are  remarkably  crenuiate. 


26 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


Cranium  1 
(. Plates  I,  II) 

Excepting  a spot  on  the  right  side,  which  is  somewhat  weathered  and 
eroded  through  exposure,  this  skull  is  firm,  strong,  ami  exceedingly 
well  preserved.  It  was  taken  from  a seinimummified  body,  and  shreds 
of  tissue  remain  attached.  It  displays  a single  operation,  so  far  com- 
pleted as  to  reveal  the  methods  pursued  by  the  primitive  practitioner 
with  remarkable  clearness,  together  with  an  incomplete  supplementary 
incision.  The  thickness  of  bone,  measured  on  the  incisions,  is  6 to 
7 mm.  The  condition  of  sutures  and  teeth  indicates  mature  but  not 
advanced  age. 

The  operation  was  located  near  the  crown,  i.  e.,  in  the  upper  and  for- 
ward part  of  the  left  parietal,  involving  the  sagittal  suture  and  ap- 
proaching the  frontal.  The  aperture  is  an  approximate  parallelogram, 
averaging  17  by  22  mm.,  measured  on  the  outer  surface,  and  about  2£ 
mm.  less,  in  either  dimension,  measured  on  the  inner  surface.  As 
clearly  shown  by  the  projecting  extremities,  the  rectangular  button  was 
dissevered  by  means  of  two  pairs  of  approximately  parallel  incisions, 
crossing  approximately  at  right  angles.  All  of  the  incisions  were  more 
extended  than  the  aperture,  ranging  from  42  to  50  mm.  in  length.  The 
incisions  are  V-shape  in  cross-section;  none  end  abruptly,  but  simply 
narrow  and  shallow  to  the  points  of  termination.  The  two  more  nearly 
longitudinal  incisions  are  sharply  defined  quite  to  the  termini,  though 
there  is  a minor  cut  nearly  parallel  to  the  medial  cut  (shown  in  plate  i), 
indicating  a change  in  position  and  direction  of  the  incision  early  in 
the  operation.  The  lateral  extremities  of  the  transverse  incisions  are 
somewhat  indefinite,  showing  a number  of  scratches  and  cuts  produced 
by  slips  or  clumsy  manipulation  of  the  instrument.  (These  marks  are 
imperfectly  reproduced  in  the  plates.)  All  four  of  the  principal  inci- 
sions penetrated  both  tables  of  the  skull  for  a part  of  their  length,  both 
the  transverse  cuts  (especially  the  posterior  one)  passing  beyond  the 
medial  longitudinal  incision  in  such  manner  as  to  show  that  the  intra- 
cranial tissues  must  have  been  injured  by  the  operation ; while  at  the 
latero-posterior  angle  the  rudely  executed  incisions  did  not  extend  quite 
through  the  inner  table,  and  a projecting  edge  of  bone  remains,  sug- 
gesting that  the  button  was  removed  by  the  use  of  an  elevator  inserted 
at  the  medio-anterior  corner. 

There  is  no  indication  of  effort  to  smooth  the  sharp  edges  left  by  the 
cutting,  nor  is  there  any  indication  of  subsequent  growth.  Moreover, 
there  is  some  discoloration  of  the  bone  about  the  incision,  indicating' 
incipient  decomposition  in  advance  of  mummification.  Accordingly  it 
seems  probable  that  the  individual  did  not  survive  the  operation — indeed 
the  posterior  transverse  incision  must  have  penetrated  the  meninges 
and  invaded  the  cerebral  tissue  for  a length  of  12  mm.  and  a depth  and 
width  of  2 or  3 mm.,  and  must  have  produced  or  hastened  death. 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL. 


SUPERIOR  ASPECT  OF  CRANIUM  1,  FROM  HUAROCHIRI 


BUREAU  OF  AMERICAN  ETHNOLOGY 


LEFT  LATERAL  ASPECT  OF  CRANIUM 


ANTERIOR  ASPECT  OF  SQUIER’S  “INCA  SKULL 


BUREAU  OF  AMERICAN  ETHNOLOGY 


SIXTEENTH  ANNUAL  REPORT  PL.  Ill 


muniz — mc gee]  OPERATION  P>Y  RECTILINEAR  INCISION  27 

Tlie  supplementary  incision  is  about  20  nun.  below  the  aperture,  near 
the  center  of  the  anterior  part  of  the  left  parietal,  and  nearly  parallel 
with  the  more  nearly  longitudinal  incisions  of  the  principal  operation. 
It  is  precisely  like  the  main  incisions,  V-shape  in  section,  42  mm.  long, 
5 mm.  wide,  and  6 mm.  deep  toward  the  center,  where  it  does  not  cpiite 
penetrate  the  inner  table  of  the  skull,  narrowing  and  shallowing  gradu- 
ally toward  the  extremities.  Just  below  its  center  there  is  a transverse 
scratch  (hardly  visible  in  the  plate),  apparently  marking  a transverse 
incision  barely  started  when  this  part  of  the  operation  was  abandoned. 
There  is  a similar  faint  scratch  back  of  the  main  aperture,  between  and 
behind  the  main  longitudinal  incisions,  and  approximately  parallel  with 
them,  which  appears  in  the  reproduction. 

The  preservation  of  the  specimen  is  so  perfect  as  to  reveal  even  the 
faintest  scratches  produced  in  connection  with  the  operation,  and  thus 
to  indicate  the  character  of  the  instrument  and  the  mode  of  its  use. 
The  scratches,  both  random  and  at  the  ends  of  some  of  the  incisions, 
show  that  the  instrument  had  a single  moderately  sharp  point,  thicken- 
ing rapidly  to  3 or  4 mm.  within  C or  7 mm.  from  the  tip;  that  not  only 
the  point  but  the  sides  bit  into  and  ground  away  the  bone  as  it  was 
manipulated ; and  that  the  manipulation  could  only  have  been  a recipro- 
cal motion  back  and  forth  from  end  to  end  of  the  incision,  accompanied 
by  considerable  pressure.  It  is  noteworthy  that  no  known  metal  instru- 
ment or  implement  would  produce  the  general  and  special  features  of 
the  incisions  in  this  cranium,  while  all  the  features  of  incisions  and 
scratches  are  precisely  such  as  would  be  produced  by  a sharpened  stone 
in  the  form  of  a spearhead,  arrowpoint,  or  knife. 

In  addition  to  the  operation  and  supplementary  incision,  the  cranium 
displays  a few  significant  marks.  The  most  conspicuous  of  these  is 
almost  exactly  in  the  center  of  the  frontal  bone,  some  40  mm.  above 
the  orbital  ridges;  it  is  a narrow,  longitudinal  contusion,  20  mm.  in 
length,  along  which  the  bone  is  crushed  irregularly,  in  such  manner  as 
to  indicate  impact  of  a moderately  sharp  but  rough-edged  instrument, 
the  force  of  impact  being  such  as  to  produce  a curvilinear  crack  in  the 
outer  table,  nearly  parallel  with  the  contusion,  and  joining  it  at  the 
euds.  The  appearance  of  this  lesion  indicates  that  it  was  produced 
during  life,  though  there  are  no  marks  of  reparative  process.  Hear  the 
left  margin  of  the  frontal  bone,  some  50  mm.  above  the  left  orbit,  there 
are  two  deep  grooves  2 or  3 mm.  wide  and  15  mm.  and  20  mm.  long, 
respectively, partly  obliterated  by  reparative  process,  evidently  marking- 
old  wounds.  (The  three  marks  are  concealed  beneath  the  label.) 

For  comparison  with  the  Muniz  specimens,  a photomechanical  repro- 
duction of  the  “Inca  skull.”  brought  from  a cemetery  in  the  valley  of 
Yucay,  Pern,  by  E.  G.  Squier,  is  introduced  in  plate  m,  from  a photo- 
graph taken  in  the  United  States  Army  Medical  Museum.1  The  oper- 

1 A wood  eDgraving  from  this  photograph  forms  plate  vii  of  Dr  Fletcher’s  memoir  “On  Prehistoric 
Trephining  and  Cranial  Amulets,’’  cited  above.  A wood  engraving  of  the  same  skull  appears  on 
p.  457 of  Squier’s  “Peru — Incidents  of  Travel  and  Exploration  in  the  Land  of  the  Incas.” 


28 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


atiou  displayed  by  this  specimen  is  precisely  similar  to  that  exemplified 
in  cranium  1 of  the  Muniz  collection;  the  aperture  is  0.58  inch  by  0.70 
inch.  The  Squier  specimen  shows  (obscurely  in  the  accompanying 
plate)  the  extent  of  the  removal  of  the  periosteum.  It  was  examined 
by  Broca,  who  thought  this  was  done  eight  or  ten  days  before  death,  and 
by  Xelaton,  who  suggested  that  the  subject  might  have  survived  fifteen 
days.1 

Cranium  2 
{Plates  IV,  Y) 

This  specimen,  like  the  last,  is  finely  preserved  and  strong,  and  bits  of 
stout  tendon  remain  attached.  The  frontal  and  temporo-parietal  sutures 
are  nearly  auchylosed,  though  the  lambdoid  is  distinct  (showing  sev- 
eral supernumeraries),  indicating,  on  the  whole,  full  maturity.  The 
specimen  shows  a single  operation,  about  which  the  bone  is  5 or  G mm. 
in  thickness. 

The  operation  was  located  near  the  posterior  angle  of  the  right  pari- 
etal, approaching  both  the  sagittal  and  lambdoid  sutures.  As  in  the  first 
cranium,  an  approximately  rectangular  button  was  dissevered  by  means 
of  two  pairs  of  parallel  iucisions.  The  aperture  is  remarkably  small, 
averaging  9 by  10  mm.  measured  on  the  outer  surface  and  consider- 
ably less  measured  on  the  inner  surface.  The  incisions  are  V-shape  in 
section  and  project  beyond  the  aperture,  though  much  less  than  in  the 
first  specimen;  the  longitudinal  incisions  are  the  longer,  measuring 
about  26  and  35  mm.,  respectively,  and  show  random  scratches  toward 
the  posterior  extremities;  the  transverse  incisions  are  only  16  or  17  mm. 
in  length,  barely  crossing  the  transverse  incision  on  one  side  and  pro- 
jecting but  4 or  5 mm.  on  the  other.  The  iucisions,  like  those  in  the 
first  specimen,  show  every  indication  of  having  been  made  by  a siugle- 
point,  tapering  instrument,  so  constructed  as  to  abrade  on  the  sides 
as  well  as  at  the  tip;  they  are  much  too  wide  and  too  strongly  curved 
in  plan  and  section  to  permit  the  supposition  that  the  instrument  was 
metal,  and  are  just  such  as  would  be  produced  by  a stone  tool.  The 
operation  would  appear  to  have  been  more  skilfully  performed  than 
the  last,  since  the  incisions  are  much  shorter  in  proportion  to  their 
depth,  and  so  placed  as  to  involve  a minimum  expenditure  of  labor 
and  suffering,  in  view  of  the  rude  character  of  the  instruments  employed. 
Two  of  Ihe  incisions  only  appear  to  have  penetrated  the  bone,  and  the 
rough  edges  of  the  inner  table  remaining  indicate  that  an  elevator  was 
applied  to  break  out  the  button  so  soon  as  the  bone  was  sufficiently 
attenuated,  while  the  superior  and  lateral  kerfs  evidently  penetrated 
not  only  the  inner  table  but  the  meninges.  There  is  no  sign  of  smooth- 
ing of  the  sharp  edges  of  the  bone  after  the  operation,  nor  is  there  any 
trace  of  reparative  growth  to  indicate  survival;  moreover,  there  is 
some  local  discoloration  of  the  skull  suggesting  local  decomposition 
before  mummification.  In  addition,  the  bone,  for  some  distance  about 


1 Peru,  op.  cit.,  577. 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  IV 


POSTERIOR  ASPECT  OF  CRANIUM  2,  FROM  HUAROCHIRI 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL. 


RIGHT  LATERAL  ASPECT  OF  CRANIUM 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  VI 


SUPERIOR  ASPECT  OF  CRANIUM  3,  FROM  CANETE 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  VII 


RIGHT  LATERAL  ASPECT  OF  CRANIUM 


MUNIZ— MC  GEE] 


OPERATION  BY  RECTILINEAR  INCISION 


29 


Ibe  point  of  operation,  displays  a somewhat  corroded  and  spongy 
appearance,  indicating  an  abnormal  condition  during  life,  probably 
periostitis.  Thus  there  is  a suggestion  that  the  operation  was  ante- 
mortem, and  connected  with  a diseased  condition:  and  there  are  indi- 
cations that  the  sufferer  did  not  survive  the  treatment. 

This  cranium  displays  also  a few  marks  apparently  due  to  old  contu- 
sions or  wounds,  nearly  obliterated  by  reparative  process;  the  most 
conspicuous  are  clearly  shown  in  .the  reproductions  on  the  right  anil 
left  of  the  operation  in  a somewhat  higher  horizontal  plane  (these  may 
be  pathologic) ; and  there  is  a long  vertical  groove  over  the  left  temple. 

Cranium  3 
( Plates  IT,  VII) 

i This  specimen  is  much  weathered  and  eroded,  no  trace  of  tissue 
remains,  and  the  weaker  bones  and  processes  are  fragmentary  or 
absent.  The  condition  of  the  sutures  indicates  maturity.  A single 
operation  is  displayed,  revealing  a thickness  of  bone  varying  from 
5 to  7 mm. 

The  operation  was  performed  on  the  right  side  of  the  crown,  i.  e.,  near 
the  middle  of  the  upper  margin  of  the  left  parietal,  apparently  just 
involving  the  sagittal  suture.  While  the  condition  of  the  skull  is  not 
such  as  to  indicate  the  details  of  the  operation,  it  evidently  consisted  in 
making  two  pairs  of  approximately  parallel  orthogonal  incisions,  as  in 
the  previous  cases.  The  aperture  is  large,  averaging  35  by  40  or  4 2 
mm.,  measured  on  the  outer  surface,  and  2 or  3 mm.  less  in  either 
dimension  measured  on  the  interior;  but  the  transverse  (and  longer) 
dimensions  can  not  accurately  be  determined,  since  the  narrow  selvage 
of  bone  between  the  superior  longitudinal  incision  and  the  sagittal 
suture  is  lost.  The  incisions  projected  somewhat  beyond  their  ortkogo- 
nals,  in  one  case  so  much  as  8 or  9 mm.,  and  the  bone  is  well  enough 
preserved  to  show  that  they  were  V-shape  in  section,  narrowing  and 
shallowing  to  the  termini,  as  in  the  preceding  specimens. 

There  is  nothing  to  indicate  whether  the  operation  was  late  ante- 
mortem or  early  post-mortem,  no  smoothing  of  sharp  edges,  no  repara- 
tive growth,  no  indications  of  diseased  condition  of  bone  or  periosteum, 
no  definite  trace  or  lesion  other  than  that  of  the  operation. 

Cranium  4 
(Plates  VIII  IX) 

This  specimen  is  bleached  and  somewhat  weathered  and  brokeo, 
though  in  good  condition  about  the  locus  of  the  single  operation.  The 
sutures  are  incipiently  anchylosed,  indicating  maturity,  though  the 
posterior  molars  are  immature.  The  cranium  is  much  lighter  and 
thinner  than  the  average  of  the  collection,  being  fairly  comparable  in 
this  respect  with  the  Caucasian  normal;  as  revealed  in  the  aperture, 
the  bone  ranges  from  2 to  34  mm.  in  thickness. 


30 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


The  operation,  located  in  the  frontal  bone  on  and  to  the  left  of  the 
median  line,  cornering  just  above  the  left  orbital  ridge,  was  incomplete. 
It  comprised  two  approximately  orthogonal  trios  of  approximately 
rectilinear  incisions,  each  similar  to  those  of  the  preceding  specimens, 
so  placed  as  to  describe  four  contiguous  quadrilateral  buttons,  of  which 
one  remains  in  place.  The  aperture,  if  completely  opened,  would  aver- 
age about  30  by  37  mm.  The  six  incisions  are  V-sliape  in  section,  nar- 
rowing and  shallowing  to  the  termini,  and  project  3 to  14  mm.  beyond 
their  ortliogonals;  and  there  are  a few  random  scratches,  giving  the 
usual  testimony  concerning  the  character  of  the  instrument  employed. 
The  incompleteness  of  the  opening,  in  conjunction  with  the  relations  of 
tbe  incisions,  indicate  clearly  the  procedure  of  the  operator.  Evidently 
the  operation  was  begun  with  only  a vague  notion  as  to  the  dimensions 
of  the  button  to  be  removed,  and  tbe  operator  clumsily  located  the 
incisions  in  indefinite  fashion  rather  than  in  accordance  with  a clearly 
formed  plan;  and  as  the  two  outer  incisions  approached  the  supra- 
orbital ridge  they  were  diverted  by  that  prominence  in  such  manner  as 
to  give  them,  particularly  the  longitudinal  cut,  a curvilinear  form. 
The  appearance  of  the  kerfs  indicates  tha  t the  lateral  longitudinal  inci- 
sion through  a part  of  its  length,  the  anterior  transverse  incision  for  a 
short  distance,  and  both  the  central  incisions,  completely  penetrated 
the  inner  table  and  invaded  the  intracranial  tissues,  but  that  in  gen- 
eral the  incisions  were  not  carried  entirely  through  the  bone,  and  some- 
times only  into  the  diploe,  when  the  operator  had  recourse  to  an 
elevator.  The  marks  indicate  also  that  the  elevator  was  inserted  over 
the  interior  angle  of  the  medio-posterior  button  (or  quarter  button)  in 
such  manner  as  to  lift  the  inner  edges  of  one  or  more  of  the  other  but- 
tons, and  that  pressure  was  exerted  until  they  were  broken  out,  singly 
or  together,  and  until  the  corner  of  the  remaining  button  was  chipped 
or  spalled  off  under  the  strain.  At  this  stage  the  operation  was  aban- 
doned, the  sharp  edges  of  broken  bone  being  left  untouched;  and  there 
is  no  trace  of  reparative  growth. 

There  is  nothing  to  indicate  certaiidy  whether  the  operation  was  late 
ante-mortem  or  early  post-mortem,  further  than  the  abandonment  of 
an  incomplete  operation  suggesting  death  in  the  hands  of  the  operator, 
and  the  cuts  extending  through  the  bone  and  into  the  cerebral  tissues 
in  such  manner  as  probably  to  produce  fatal  results;  nor  are  there 
traces  of  antecedent  lesion. 

There  is  a depression  about  the  center  of  the  right  half  of  the  frontal 
bone,  apparently  the  record  of  a blow  received  long  before  death. 

Cranium  5 
( Plates  AT,  XI) 

This  specimen  is  one  of  the  largest  in  the  collection;  it  is  in  good 
condition,  having  been  taken  from  a mummified  body  in  a fair  state 
of  preservation.  The  sutures  and  teeth  indicate  approaching  maturity. 
The  skull  is  strong  and  symmetric,  though  thinner  than  the  average 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  VIII 


ANTERIOR  ASPECT  OF  CRANIUM  4,  FROM  HUAROCHIRI 


BUREAU  OF  AMERICAN  ETHNOLOGY 


SIXTEENTH  ANNUAL  REPORT  PL.  IX 


SUPERIOR  ASPECT  OF  CRANIUM  4 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL. 


ANTERIOR  ASPECT  OF  CRANIUM  5,  FROM  HUAROCHIRI 


BUREAU  OF  AMERICAN  ETHNOLOGY 


SIXTEENTH  ANNUAL  REPORT  PL.  XI 


SUPERIOR  ASPECT  OF  CRANIUM  5 


MUNIZ—  MC  GEE] 


OPERATION  BY  MULTIPLE  INCISION 


31 


of  the  collection,  ranging  from  2^  to  mm.  about  the  single  exten- 
sive aperture.  There  are  three  distinct  interparietal  bones,  one  25  mm. 
across,  the  other  smaller. 

The  operation  represented  by  the  specimen  was  performed  on  the 
right  side  of  the  frontal  bone,  extending  from  the  median  line  to  the 
coronal  suture,  passing  about  30  mm.  above  the  orbit.  It  was  per- 
formed by  means  of  a number  of  rectilinear  incisions  of  the  usual 
V-shape  section  and  attenuated  termini.  While  somewhat  random  in 
distribution,  the  outer  incisions  cross  at  large  angles,  describing  a 
somewhat  irregular  polygon.  In  addition  to  those  made  about  the 
aperture,  there  are  others  extending  over  to  the  left  side  of  the  frontal 
bone,  indicating  far-reaching  exploratory  and  tentative  cutting  on  the 
part  of  the  operator;  and  a series  of  shallow  scratches  extends  back- 
ward from  the  lateral  extremity  of  the  aperture  for  25  mm.  on  the  left 
parietal.  Including  the  minor  scratches,  there  were  at  least  twenty 
different  incisions,  nearly  all  penetrating  the  outer  table,  with  at  least 
four  or  five  penetrating  the  inner  table,  in  some  cases  so  far  as  evi- 
dently to  penetrate  also  the  dura  mater.  It  would  appear  that,  after 
this  hacking  of  the  skull,  the  operator  raised  the  included  fragment  or 
fragments,  probably  in  several  pieces,  by  means  of  elevators,  producing 
an  aperture  fully  65  mm.  long  by  33  mm.  in  maximum,  and  some  24  mm. 
in  average  width.  There  was  no  final  smoothing  of  sharp  edges;  and 
naturally  there  is  no  indication  of  subsequent  reparative  process. 

In  this  case,  as  in  the  last,  there  is  a lack  of  conclusive  evidence  as 
to  whether  the  operation  was  late  ante-mortem  or  early  post-mortem, 
though  not  only  the  abandonment  of  the  operation  and  the  nature  of 
the  wound  produced  thereby,  but  a decided  local  staining  of  the  skull 
and  absence  of  soft  tissues,  bringing  to  mind  the  interpretation  by  the 
Peruvian  commission  of  the  fatal  wounding  recorded  in  the  cranium  of 
Pizarro,1  suggest  that  the  instrumentation  was  ante-mortem  and  fatal  in 
its  results.  There  is  no  unmistakable  trace  of  lesion  other  than  the 
slashes  of  the  rude  instrument  with  which  the  operation  was  performed, 
unless  it  be  an  irregular  scar  or  sinuous  scratch,  about  1 mm.  broad  and 
half  as  deep,  skirting  the  right  supraorbital  ridge  to  the  median  line,  and 
thence  wandering  upward  and  toward  the  left  to  a point  30  mm.  above 
the  center  of  the  left  orbit,  which  on  the  whole  seems  to  be  post-mortem. 

It  may  be  observed  that  both  these  cases  show  that  it  could  not  have 
been  the  design  of  the  operator  to  obtain  a button  or  rondelle,  since  the 
incisions  were  so  placed  as  to  divide  the  extracted  piece  into  fragments. 

Cranium  6 

( Plate  XII ) 

This  fragmentary  specimen  is  a well-preserved  right  parietal  bone  of 
a relatively  thin  cranium,  measuring  34  to  44  mm.  about  the  single 

luThe  Remains  of  Don  Francisco  Pizarro,”  American  Anthropologist,  vol.  Yii,  1894,  pp.  1-25,  espe- 
cially p.  7. 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16! 


artificial  aperture.  The  bone  is  somewhat  bleached  and  cracked,  but 
is  in  sufficiently  good  condition  to  indicate  clearly  the  modus  operandi. 

The  locus  of  the  operation  is  near  the  posterior  angle  of  the  bone, 
centering  about  40  nun.  to  the  right  of  the  sagittal  suture,  and  the 
same  distance  above  the  lambdoid.  The  aperture  is  elliptical,  measur- 
ing about  22  by  43  rum.  on  the  outer  surface,  somewhat  less  on  the 
inner.  Evidently  it  was  performed  chiefly  by  means  of  a single  curvi- 
linear incision,  apparently  followed  by  the  use  of  an  elevator;  and  the 
scratches  leaving  the  upper  incision  show  that  the  curvilinear  character 
was  given  by  gradually  changing  the  direction  of  the  reciprocal  or  saw- 
ing motion  as  the  incision  was  extended  from  the  anterior  extremity 
inward  and  backward.  The  marks  indicate,  too,  that  the  instrument 
was  a somewhat  blunt  single- point  blade,  which  ground  the  bony  sub- 
stance with  rough  sides  as  well  as  a jagged  tip.  The  sharp  edges  pf  the 
bone  were  not  reduced  after  the  operation,  nor  is  there  any  sign  of 
subsequent  physiologic  process. 

In  this,  as  in  some  other  cases,  there  is  no  certain  means  of  determin- 
ing whether  the  operation  was  ante-mortem  or  post-mortem,  though  it 
must  have  dated  about  the  time  of  death;  but  in  this  instance  there  i& 
fairly  decisive  evidence  that  the  operation  was  located  by  an  antecedent 
lesion.  Seven  or  8 mm.  outside  the  posterior  extremity  of  the  aperture 
there  is  a curvilinear  crack  in  the  outer  table  of  the  skull  which,  though 
partially  obliterated  by  exploratory  Scratches,  can  easily  be  traced  to 
its  passage  into  the  lower  side  of  the  aperture,  where  it  invades  the 
inner  table  and  coincides  with  the  margin  of  the  opening  thence  nearly 
to  its  anterior  extremity.  While  it  would  seem  barely  possible  that  this 
fracture  might  have  been  produced  in  connection  with  the  operation, 
the  indications  are  much  stronger  (amounting  almost  to  conclusive  evi- 
dence) that  it  antedated  the  operation,  and  was  part  of  a depressed 
fracture,  in  which  the  bone  was  broken  through  in  undercut  fashion 
on  the  lower  side  of  the  aperture,  and  bent  inward  above,  where  the 
incision  was  afterward  placed. 

Cranium  7 
(. Plates  XIII-XY) 

This  specimen  is  fairly  preserved,  having  been  taken  from  a mummi- 
fied body,  though  it  is  weathered  about  the  lower  part  of  the  left  side, 
and  somewhat  about  the  occiput;  uo  tissue  remains,  but  portions  of 
the  bone  are  fatty  and  gelatinous.  The  skull  is  quite  thick  and  strong, 
with  an  immense  occipital  protuberance;  it  measures  6 to  8 mm.  in 
thickness  about  the  loci  of  the  two  operations.  The  temporo-parietal 
sutures  were  incipiently  anchylosed,  as  was  also  the  coronal,  especially 
on  the  right,  though  the  sagittal  and  lambdoid  remain  conspicuous, 
the  condition  on  the  whole  indicating  full  maturity.  There  are  two  or 
three  irregular  interparietals;  while  the  metopic  suture  is  distinctly 
preserved. 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XII 


RIGHT  LATERO-POSTERO-SUPERIOR  ASPECT  (INVERTED)  OF  CRANIUM  6,  FROM  HUAROCHIRI 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XIII 


ANTERIOR  ASPECT  OF  CRANIUM  7,  FROM  CUZCO  (DOUBLE-TREPHINED) 


BUREAU  OF  AMERICAN  ETHNOLOGY 


LEFT  LATERAL  ASPECT  OF  CRANIUM 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XV 


POSTERIOR  ASPECT  OF  CRANIUM 


MUNIZ — MC  GEE] 


OPERATION  BY  CURVILINEAR  INCISION 


33 


Of  tlie  two  operations  displayed,  the  clearer  as  regards  raocius  oper- 
and i is  high  in  the  frontal  bone,  invading  the  metopic  suture,  and 
centering  30  mm.  below  the  coronal.  The  aperture  is  approximately 
circular,  averaging  some  27  mm.  in  diameter,  measured  on  the  outer 
surface,  and  rather  less  than  20  mm.  measured  on  the  inner  surface. 
While  the  marks  of  the  instrument  are  indistinct,  the  general  character 
of  the  incisions  is  fairly  indicated.  The  most  clearly  defined  incision  is 
an  approximately  rectilinear  cut  25  mm.  long,  defining  the  left  side  of 
the  aperture,  curving  anteriorly  toward  the  metopic  suture,  which  it 
just  reaches  some  20  mm.  beyond  the  point  of  sharpest  curvature.  The 
other  side  of  the  aperture  is  defined  chiefly  by  two  fractures,  one  of 
which  apparently  was  located  by  an  incision  some  20  mm.  in  length  just 
on  the  right  of  and  parallel  to  the  metopic  suture.  So  far  as  preserved, 
the  principal  incision  is  V-shape  in  section,  attenuating  toward  one 
extremity  but  becoming  indefinite  toward  the  other;  and  it  seems  to 
have  been  carried  through  the  outer  table  throughout  most  of  its  length 
and  around  the  sharper  part  of  the  curve,  and  also  nearly  or  quite 
through  the  inner  table  about  the  middle  part  of  its  length;  then,  as 
the  walls  of  the  aperture  indicate,  an  elevator  was  inserted  and  the 
button  was  broken  out  entire  or,  more  probably,  in  fragments  by  lever- 
age over  the  firm  bone  outside  the  region  of  cutting.  Striae  extending 
from  the  termini  of  the  two  horizontal  incisions  indicate  slipping  of  the 
instrument,  or  preliminary  exploratory  cutting;  and  these,  together 
with  the  features  of  the  main  incisions,  bear  the  usual  testimony  as  to 
the  use  of  a single-point  blunt  instrument,  apparently  of  stone.  The 
extension  and  conformation  of  the  cuts  are  best  explained  on  the  sup- 
position that  the  operator  occupied  a rather  low  seat  and  held  the  head 
of  the  patient  (sitting  or  reclining  on  the  ground  or  floor  facing  toward 
the  operator’s  right)  between  his  knees,  using  his  right  hand  for  the 
cutting,  and  sometimes  turning  the  head  slightly  as  the  work  pro- 
gressed. The  sharp  edges  of  bone,  particularly  in  the  outer  table,  were 
finally  smoothed  off,  though  whether  intentionally  by  the  operator  or 
subsequently  by  reparative  process  is  somewhat  questionable;  yet  the 
condition  of  both  tables  and  diploe  indicate  with  practical  certainty  that 
the  sufferer  survived  the  operation  for  months  or  years.  No  trace  of 
lesion  antecedent  to  the  operation  appears,  and  the  bone  is  so  thick 
and  the  aperture  so  small  as  almost  to  prove  that  there  could  have 
been  no  antecedent  depressed  fracture  or  related  injury. 

The  locus  of  the  other  and  earlier  operation  is  the  upper  left  portion 
of  the  occipital,  just  invading  the  lambdoid  suture.  The  aperture  is 
elliptical,  measuring  18  by  23  mm.  between  the  narrowest  portions  of 
the  walls.  At  this  point  the  skull  is  somewhat  eroded  by  weathering, 
and  the  margins,  especially  toward  the  lambdoid,  are  slightly  crumbled ; 
yet  the  state  of  preservation  suffices  to  indicate  long-continued  repara- 
tive process  whereby  the  bony  margins  were  smoothed  and  rounded, 
the  diploe  completely  obliterated,  and  all  traces  of  instrumentation 
16  ETII 3 


34 


PRIMITIVE  TREPHINING  IM  PERU 


[ETH.  ANN.  1C 


eliminated.  In  a general  way  the  operation  would  seem  to  liave  been 
similar  to  the  later  one  in  the  anterior  part  of  the  head,  though  doubt- 
less performed  several  years  earlier.  As  in  the  later  operation,  traces  of 
antecedent  lesion  are  conspicuously  absent,  and  the  attendant  features 
are  hardly  consistent  with  the  supposition  of  considerable  traumatic 
injury. 

The  usual  long-healed  grooves  over  the  temples  appear  in  the  speci- 
men, two  of  exceptional  length  on  the  right  and  two  or  three  on  the 
left;  there  are  no  other  scars  or  abnormal  features,  save  the  vestigial 
preservation  of  the  metopic  suture. 

Cranium  8 

{Plate  XVI) 

Although  fragmentary  only,  this  specimen  is  well  preserved,  and 
represents  a large  and  strong  cranium,  the  bones  averaging  5 mm.  or 
more  in  thickness.  The  sagittal  suture  is  almost  completely  anchylosed, 
and  the  lambdoid  greatly  obscured,  indicating  fully  mature  age.  The 
specimen  displays  a well-defined  artificial  aperture  in  addition  to  a 
smaller  opening,  possibly  artificial  but  more  probably  a pathologically 
persistent  parietal  foramen. 

The  undoubted  operation  was  located  on  the  top  of  the  head,  i.  e., 
near  the  antero-superior  angle  of  the  right  parietal,  centering  28  mm. 
from  the  sagittal  suture  and  35  mm.  from  the  coronal.  The  aperture 
is  approximately  circular,  averaging  30  mm.  measured  on  the  outer 
surface  and  27  mm.  on  the  inner.  The  traces  of  primary  instrumenta- 
tion are  indistinct  ; yet  they  appear  to  indicate  careful  manipulation  of 
a blunt  single-point  cutting  and  grinding  tool,  held  vertically  on  one 
side  and  obliquely  on  the  other  and  worked  with  a short  reciprocal  or 
sawing  motion  in  curvilinear  fashion,  in  such  manner  as  to  define  the 
circular  aperture.  The  conformation  of  the  cutting  suggests  an  atti- 
tude of  operator  and  position  similar  to  that  suggested  by  cranium  7, 
save  that  the  patient  faced  toward  the  operator’s  left;  the  head  was 
apparently  rotated  considerably  as  the  cutting  progressed,  while  the 
position  of  the  tool,  as  held  in  the  right  hand,  was  somewhat  oblique, 
undercutting  slightly  on  the  side  of  the  aperture  toward  the  operator’s 
left,  and  overcutting  considerably  on  the  other  side.  It  would  seem 
that  the  random  scratches  due  to  slipping  of  the  tool,  particularly  on 
the  posterior  and  inferior  sides  of  the  opening,  were  subsequently 
ground  or  rasped  away  by  rubbing  with  a rough  tool  which  left  fine 
but  irregular  scratches  in  the  outer  table.  A few  aberrant  cuts  extend- 
ing some  distance  from  the  aperture  remain;  two  of  these,  parallel  to 
the  sagittal  suture,  extend  forward  from  the  aperture,  one  for  15  mm. 
and  the  other  for  22  mm.  to  the  coronal  suture,  as  shown  in  the  repro- 
duction. Despite  the  persistence  of  these  marks,  the  character  of  the 
margins  of  both  inner  and  outer  tables  indicates  that  the  patient  sur- 
vived the  operation,  and  that  slow  reparative  changes,  not  however 
extending  to  material  bony  growth,  supervened. 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XVI 


SUPERIOR  ASPECT  (INVERTED)  OF  CRANIUM  8,  FROM  HUAROCHIRI 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XVII 


ANTERIOR  ASPECT  OF  CRANIUM  9,  FROM  HUAROCHIRI 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XVIII 


LEFT  LATERAL  ASPECT  OF  CRANIUM 


MUNIZ— MC  GEE 


OPERATION  CERTAINLY  ANTE-MORTEM 


OO 


There  is  no  certain  indication  of  lesion  antecedent  to  the  operation, 
though  a fracture,  defining-  the  anterior  edge  of  the  right  parietal  in 
the  broken  cranium,  passes  the  sagittal  suture  and  extends  into  the 
aperture;  it  is,  however,  probable  that  this  fracture  was  long  post- 
mortem and  produced  on  collecting  the  specimen. 


Cranium  9 
(. Plates  XVII,  XYIII ) 

The  principal  bones  of  this  specimen  are  fairly  preserved,  though 
somewhat  bleached.  The  skull  is  rather  small  and  thinner  than  the 
mean  of  the  collection,  though  the  processes  and  attachments  are 
strong;  about  the  single  artificial  aperture  it  averages  3 mm.  in  thick- 
ness. The  sagittal  suture  is  nearly  obliterated  in  the  middle  third  of 
its  length,  though  the  other  sutures  are  distinct,  the  condition  on  the 
whole  indicating  early  middle  age. 

The  operation  displayed  by  the  specimen  was  located  in  the  middle  of 
the  left  half  of  the  frontal  bone,  centering  about  45  mm.  above  the  orbit; 
it  is  elliptical,  with  one  flattened  side,  measuring  about  10  by  25  mm. 
on  the  inner  surface,  or  19  by  33  mm.  on  the  outer  surface  of  the  skull. 
4 he  margins  are  somewhat  weathered,  rendering  the  testimony  of  the 
specimen  concerning  the  operation  and  its  consequences  somewhat 
doubtful.  On  the  whole,  the  form  of  the  aperture  and  the  features 
of  the  margin  indicate  that  it  was  produced  by  a clumsy  single-point 
instrument,  such  as  a stone  spearhead,  rather  deftly  operated  in  such 
manner  as  to  produce  a curved  incision  describing  nearly  a semicircle, 
with  the  extremities  more  sharply  curved  and  joined  by  a straight 
cut;  the  instrument  being  held  nearly  vertical  while  forming  the  sides 
of  the  contemplated  aperture,  but  slanted  toward  the  ends,  either 
clumsily  or  to  facilitate  the  insertion  of  an  elevator.  Apparently 
the  edges  of  the  aperture  were  afterward  smoothed  somewhat;  yet 
the  condition  of  the  bone,  including  the  obliteration  of  the  diploe  by 
local  replacement,  indicates  considerable  reparative  process,  extending 
to  the  growth  of  bony  spicules,  now  largely  removed  by  weathering 
and  erosion.  It  is  unquestionable  that  the  operation  was  ante-mortem, 
and  that  the  sufferer  survived,  probably  for  years. 

While  there  is  no  clear  indication  of  antecedent  lesion,  there  is  a faint 
line  parallel  with  the  superior  side  of  the  aperture  and  3 or  4 mm.  dis- 
tant (which  does  not  appear  in  the  reproduction),  possibly  marking  the 
limit  of  a small  depressed  fracture. 

Cranium  10 
( Plates  XIX,  XX) 

This  is  a well-preserved  skull,  considerably  stained  with  ocher  or  cave 
earth.  It  is  small  but  strong,  with  the  usual  splendidly  developed  liga- 
ment attachments,  and,  though  some  5 mm.  thick,  has  been  preserved 
in  such  manner  as  to  be  exceptionally  light.  Some  of  the  sutures  are 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


36 

anchylosed  and  partly  obliterated  and  others  distinct,  while  the  teeth 
are  fairly  developed,  except  that  one  posterior  molar  is  lacking  and  the 
other  imperfect,  the  features  collectively  indicating  middle  age. 

The  operation  displayed  by  this  specimen  is  in  the  posterior  angle  of 
the  right  parietal,  extending  to  both  sagittal  and  lambdoid  sutures. 
The  aperture  is  rudely  circular  and  28  or  29  mm.  in  mean  diameter. 
Although  the  bone  is  in  excellent  preservation,  it  is  impossible  to  deter- 
mine the  manner  in  which  the  operation  Avas  performed,  since  all  definite 
traces  of  instrumentation  have  been  obliterated  by  reparative  process, 
including  the  complete  replacement  of  the  diploe  and  the  development 
of  strong  spicules  of  new  bone  pushing  into  the  aperture.  The  most 
conspicuous  of  these  spicules  is  that  clearly  shown  in  both  reproductions 
at  the  lower  side  of  the  opening.  The  sharp  angle  immediately  above 
also  represents  well-developed  bony  growth.  While  the  record  of  the 
operation  is  thus  obscure,  it  is  nevertheless  fairly  if  not  finally  evident 
that  the  operator  proceeded  in  a manner  unlike  that  represented  in 
most  or  all  of  the  preceding  specimens.  The  conspicuous  feature  of  the 
artificial  work  lies  in  the  fact  that  the  bone  attenuates  uniformly  toward 
the  edges  of  the  aperture  as  if  remoA-ed  by  scraping  or  grinding,  perhaps 
with  an  edge  or  rasp-like  side  of  considerable  length.  (This  is  well 
shown  in  plate  xx.)  There  are,  however,  a few  exploratory  scratches, 
notably  one  extending  forward  from  the  upper  margin  of  the  grinding, 
30  mm.  from  and  nearly  parallel  with  the  sagittal  suture. 

No  antecedent  lesion  can  be  detected,  but  it  is  certain  that  the  patient 
survived  the  operation  long,  probably  many  years.  The  cranium  dis- 
plays three  great  grooves  over  either  temple  arranged  in  symmetric 
pairs. 

Cranium  11 
(. Plates  XXI , XXII) 

Although  somewhat  bleached  and  weathered,  this  cranium  is  in  excel- 
lent condition.  The  occiput  is  singularly  flattened,  particularly  on  the 
left,  as  shown  imperfectly  in  the  right  aspect  represented  on  plate  xxn. 
There  is  some  flattening  also  of  the  face,  Avith  an  apparently  abnormal 
shortening  of  the  mandible.  Two  or  three  small  interparietals  occur. 
The  bones  are  rather  thin,  ranging  from  2J  to  44  mm.  The  teeth  are 
exceptionally  mature  for  the  collection,  though  the  sutures  remain 
distinct. 

The  operation  for  which  the  specimen  is  notable  Avas  performed  near 
the  center  of  the  frontal  bone,  a little  to  the  right  of  the  median  line, 
and  extending  from  37  mm.  above  the  orbit  to  within  22  mm.  of  the 
coronal  suture.  The  aperture  is  an  elongated  ellipse,  21  or  22  mm.  in 
maximum  width  by  40  in  length,  measured  on  the  feather  edge  of  the 
inner  table.  In  this  case,  too,  all  definite  traces  of  instrumentation  are 
lost,  partly  by  weathering  though  chiefly  by  reparative  process.  The 
margins  of  both  tables  are  rounded,  the  diploe  is  completely  obliterated, 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XIX 


POSTERIOR  ASPECT  OF  CRANIUM  10,  FROM  CUZCO 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XX 


RIGHT  LATERAL  ASPECT  OF  CRANIUM  10 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXI 


ANTERIOR  ASPECT  OF  CRANIUM  11,  FROM  PACHACAMAC 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXII 


RIGHT  LATERAL  ASPECT  OF  CRANIUM  11 


muniz— mc  gee]  OPERATION  REPEATED  IN  SAME  REGION 


37 


and  there  are  a few  small  spicules  of  new  bone  projecting  into  the 
aperture,  notably  a sharp  point  at  the  anterior  extremity  (shown  clearly 
in  plate  xxi).  So  far  as  can  be  judged,  the  modus  operandi  was  sim- 
ilar to  that  represented  in  cranium  0,  with  subsequent  grinding  or  rasp- 
ing of  the  outer  table  to  remove  the  raw  edges;  yet  it  is  quite  possible 
that  the  aperture  was  made  wholly  by  scraping. 

No  trace  of  lesion  antecedent  to  the  operation  remains.  It  is  clear 
that  the  sufferer  lived  for  some  time,  certainly  months  and  probably 
years,  after  the  treatment.  The  usual  vertical  cut  in  the  bone  appears 
above  the  right  temple. 

Cranium  12 
(. Plates  XXIII,  XXIY) 

Although  nearly  white,  as  if  bleached,  this  cranium  was  taken  from 
a fairly  well  mummified  body,  and  fragments  of  ligaments  and  other 
tissues  remain,  while  the  bone  is  fatty.  The  specimen  is  small,  rather 
light  and  thin,  somewhat  delicate  in  outline,  with  less  conspicuously 
strong  attachments  than  most  of  the  collection;  it  is  one  of  two  crania 
suspected  to  be  feminine.  The  teeth  are  nearly  mature  and  the  sutures 
somewhat  obscured;  there  are  over  half  a dozen  little  interparietals. 

The  rather  complex  operations  were  located  about  the  center  of  the 
superior  side  of  the  occipital.  The  principal  aperture  is  rudely  circu- 
lar, interrupted  by  an  irregular  salient,  and  averages  perhaps  26  mm. 
in  diameter;  the  next  in  size  is  an  irregular  oblong  about  8 by  12  mm., 
and  the  smallest  is  an  approximate  circle  some  6 mm.  in  diameter. 
The  marks  of  instrumentation  are  rather  indefinite,  and  are  practically 
absent  about  most  of  the  margin  of  the  largest  aperture.  So  far  as 
can  be  judged,  the  initial  operation  was  begun  by  a curvilinear  incision 
extending  from  near  the  center  of  the  occiput  upward  and  forward 
nearly  to  the  lambdoid  suture,  where  it  was  curved  sharply  and  after- 
ward connected  with  another  curvilinear  incision  defining  the  medio- 
superior  side  of  the  largest  opening.  It  would  seem  probable  that  the 
principal  button  was  then  removed  by  the  aid  of  an  elevator,  leaving  a 
ragged  margin  on  the  median  side,  and  that  the  edges  of  the  outer  table 
were  then  scraped  smooth  and  neatly  beveled.  Afterward  considerable 
physiologic  action  apparently  supervened,  whereby  the  tool  marks  were 
obliterated,  while  the  diploe  was  solidified  and  the  cut  surface  brought 
into  the  condition  of  normal  bony  surface,  the  period  of  reparation  being 
probably  months,  possibly  years.  Then  ensued  the  later  operation, 
beginning  with  a transverse  rectilinear  incision  some  40  mm.  long 
extending  from  near  the  center  of  the  occiput  to  the  inferior  margin  of 
the  antecedent  aperture  and  passing  into  extensive  scraping  of  the 
bone,  thence  upward  nearly  to  the  suture  and  rightward  to  the  large 
opening.  Further  than  this,  the  modus  operandi  seems  still  more 
doubtful,  though  minute  scratches,  as  well  as  the  general  conformation, 
would  indicate  that  the  oblong  aperture  was  produced  by  scraping. 


38 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


There  is  nothing  clearly  to  indicate  how  the  smallest  aperture  was 
produced,  though  it  has  every  appearance  of  artificial  origin,  and  there 
are  decisive  indications,  in  the  preservation  of  the  tool  marks  and  the 
retention  of  normal  character  by  the  diploe,  that  both  of  the  medial 
openings  are  much  more  recent  than  the  large  one;  indeed,  it  is  doubtful 
whether  the  sufferer  survived  the  later  operation,  and  the  conformation 
of  the  smallest  aperture  indicates  pretty  clearly  that  the  underlying 
tissues  were  invaded  so  seriously  as  to  produce  death.  In  general,  the 
operations  display  some  evidence  of  both  rectilinear  and  curvilinear 
incisions,  such  as  those  characteristic  of  the  earlier  members  of  the 
series,  with  definite  indications  of  subsequent  scraping  or  grinding. 

There  is  no  definite  indication  of  antecedent  lesion;  although  the 
general  appearance  of  the  bone  and  the  distribution  of  the  openings 
vaguely  suggest  a diseased,  possibly  leprous  or  syphilitic,  condition,  the 
suggestion  vanishes  when  the  firm,  sound  bone  is  examined  closely. 
Hear  the  antero-inferior  angle  of  the  right  parietal  there  is  a darkened 
and  evidently  abnormal  tract,  more  conspicuous  in  plate  xxiv  than  in 
the  specimen,  perhaps  the  trace  of  local  ostitis  induced  by  a blow; 
there  is  also  a dent,  with  some  crushing  of  the  bone,  35  mm.  above 
the  left  orbit,  and  one  of  the  customary  vertical  grooves  appears  over 
the  right  temple. 

Cranium  13 

( Plate  XXV) 


This  specimen  is  perhaps  the  least  satisfactory  of  the  series,  chiefly 
because  of  the  weathering  and  erosion  to  which  it  has  been  subjected. 
It  is  small  but  thick,  averaging  probably  6 or  7 mm.,  with  the  usual 
prominent  occiput  and  attachments.  The  teeth  are  fairly  developed 
and  anchylosis  is  well  advanced,  indicating  maturity;  as  usual,  there 
are  several  small  interparietals. 

The  more  significant  of  the  two  operations  displayed  by  the  specimen 
was  performed  in  the  top  of  the  head,  involving  the  sagittal  suture, 
and  apparently  extending  also  into  or  across  the  coronal,  though  this 
is  rendered  somewhat  doubtful  by  weathering  and  a recent  fracture. 
This  aperture  is  oblong,  12  mm.  wide  and  (probably)  20  mm.  or  more 
long.  Ho  trace  of  instrumentation  remains;  the  margins  are  thor- 
oughly rounded  and  the  diploe  is  completely  obliterated,  giving  an  air 
of  antiquity  to  the  opening;  undoubtedly  the  sufferer  survived  the 
operation  for  many  years,  despite  the  infraction  of  a modern  rule 
against  trephining  over  sutures. 

The  locus  of  the  second  operation  was  the  upper  part  of  the  left 
parietal,  centering  about  40  mm.  from  the  earlier  one,  and  about  the 
same  distance  from  the  sagittal  and  coronal  sutures.  The  aperture  is 
oval,  about  17  mm.  in  breadth  by  22  in  length.  The  surrounding  bone 
is  somewhat  eroded,  yet  enough  of  the  original  surface  remains  to 
indicate  clearly  a reparative  rounding  by  physiologic  process,  similar 


BUREAU  OF  AMERICAN  ETHNOLOGY  . SIXTEENTH  ANNUAL  REPORT  PL.  XXIII 


POSTERIOR  ASPECT  OF  CRANIUM  12,  FROM  CUZCO  (DOUBLE-TREPHINED) 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXIV 


RIGHT  LATERAL  ASPECT  OF  CRANIUM  12 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXV 


SUPERIOR  ASPECT  OF  CRANIUM  13,  FROM  CUZCO  (DOUBLE-TREPHINED) 


MUNIZ — MC  GEE 


CRANIA  IN  MUSEUM  AT  CUZCO 


39 


to,  tkougli  less  advanced  than  in  connection  with  the  other  aperture  in 
the  same  cranium,  and  quite  similar  in  character  and  advancement  to 
that  displayed  by  the  earlier  operation  in  cranium  7.  Both  tables  dis- 
play short  and  small  knobs  or  spicules  of  reparative  growth,  and  fully 
half  of  the  margin  of  the  inner  table  shows  the  peculiar  conformation 
and  coloration  characteristic  of  such  growth,  as  may  clearly  be  seen 
in  the  reproduction.  The  diploe  is  obliterated  on  the  anterior  side  of 
the  aperture 5 on  the  posterior  side  it  was  partly  absorbed  (though 
the  spongy  texture  was  modified  through  replacement  as  in  most  of  the 
examples),  leaving  a groove  3 mm.  wide  and  2 to  3 mm.  deep  between 
the  tables.  So  extensive  are  the  subsequent  physiologic  modifications 
that  all  trace  of  instrumentation  has  been  obliterated.  Evidently  the 
sufferer  survived  this  operation,  also,  for  a considerable  period,  proba- 
bly a number  of  years. 

In  neither  case  is  there  the  slightest  trace  of  antecedent  lesion.  It 
may  be  noted  that  the  outer  table  about  the  apertures,  particularly  the 
later,  is  somewhat  rough  as  to  surface  and  vesicular  in  texture,  proba- 
bly by  reason  of  physiologic  and  post-mortem  processes  initiated  by 
the  operation,  but  possibly  because  of  caries. 

For  purposes  of  comparison  and  to  complete,  so  far  as  practicable, 
the  illustration  of  trephined  crania  from  Peru,  the  eight  specimens 
illustrated  on  plates  xxvi  and  xxvn  are  introduced.  The  reproduc- 
tions are  half-tone  engravings  from  small  photographs  obtained  by  Dr 
Muniz.  The  specimens  are  preserved  in  the  museum  at  Cuzco. 

Figures  a and  b,  plate  xxvi,  represent  crania  penetrated  by  large 
and  irregular  apertures,  showing  no  definite  traces  of  instrumentation. 
In  figure  a the  margins  are  jagged,  suggesting  the  enlargement  of  an 
original  aperture  by  the  use  of  a vigorously  applied  elevator  fulcrumed 
on  the  opposite  margin;  there  is  no  trace  of  subsequent  growth,  and 
consequently  nothing  to  indicate  the  purpose  of  the  operation,  or 
whether  it  was  late  ante-mortem  or  post-mortem.  Similarly  in  figure 
b , the  irregular  form  and  absence  of  incisions  suggest  extensive  use  of 
the  elevator;  while  the  rounded  margin,  particularly  on  the  anterior 
side  of  the  aperture,  indicates  subsequent  reparative  process,  and  thus 
shows  that  the  operation  was  ante-mortem.  In  figures  c and  d (plate 
xxvi),  in  like  manner,  all  trace  of  instrumentation  has  been  obliterated 
by  subsequent  growth,  which  in  both  cases  (particularly  the  latter)  is 
extensive  and  characteristic.  The  operation  represented  in  figure 
c involved  the  coronal  suture.  In  figure  <7,  in  less  measure  in  figure  ", 
and  to  a still  less  extent  in  figure  b,  there  are  suggestions  of  malforma- 
tion or  of  general  pathologic  condition  resulting  in  necrosis,  followed 
by  the  reparative  process  indicated;  but  the  suggestion  does  not 
demand  serious  consideration,  partly  because  of  its  improbability  in 
view  of  the  characteristics  displayed  by  the  Muniz  collection,  partly 
because  the  question  could  be  set  at  rest  only  by  examination  of  the 
crania  themselves. 


40 


PRIMITIVE  TREPHINING  TN  PERU 


[ETH.  ANN.  16 


The  specimen  illustrated  in  figure  a,  plate  xxvn,  displays  two  aper 
tures,  both  of  somewhat  doubtful  character.  One  is  an  elongated  slot, 
the  outline  and  sharp  edges  of  which  suggest  the  use  of  a metal  instru- 
ment; but  the  method  in  which  the  operation  was  performed  can  not 
be  determined  from  engraving  or  photograph.  The  cranium  repre- 
sented in  figure  b exemplifies  a mode  of  operation  distinct  from  any  of 
those  indicated  by  the  MuFiiz  collection.  In  one  case  there  are  three 
rather  small  perforations  placed  in  the  form  of  a triangle.  The  perfora- 
tions suggest  the  use  of  a drilling  or  boring  iustrument,  perhaps  simi- 
lar to  the  brima  used  by  the  Kabyle,  and  their  arrangement  suggests  that 
the  drilling  was  followed  by  the  use  of  a strong  elevator  and  the  break- 
ing out  of  the  fragment  described  by  the  perforations,  also  after  the 
manner  of  the  Kabyle.  The  large  aperture  made  above  the  right  orbit 
in  the  same  specimen  would  appear  to  have  been  produced  in  this  way. 
In  this  manner,  too,  the  huge  aperture  in  the  specimen  shown  in  figure 
«,  plate  xxvi,  might  have  been  produced.  The  reproduction  suggests 
the  employment  of  rude  metal  instruments,  although  the  operation  is  of 
no  higher  order  than  those  revealed  in  the  Muniz  collection,  and  although 
the  drilling  and  elevating  might  easily  have  been  effected  by  stone  per- 
forators and  elevators  of  bone  or  wood.  The  operations  represented  in 
figure  b and  the  elongated  opening  shown  in  figure  a (plate  xxvn) 
reveal  no  indications  of  subsequent  growth,  and  may  accordingly  have 
been  late  ante-mortem  or  post-mortem. 

The  figures  c and  d,  in  plate  xxvn,  represent  two  approximately  cir- 
cular operations,  comparable  with  several  of  those  revealed  in  the 
Muniz  sei'ies.  Viewed  in  the  light  of  these  examples,  it  would  appear 
that  both  were  performed  by  means  of  somewhat  irregular  curved  inci- 
sions, followed  by  the  use  of  the  elevator,  and  that  the  margins  were 
subsequently  beveled  by  rasping  or  scraping;  it  would  appear  also  that 
both  individuals  long  survived  the  operation,  as  indicated  by  repara- 
tive growth  and  rounding  of  surface,  and  the  partial  obliteration  of  the 
diploe. 

Cranium  14 

(. Plates  XXVIII,  XXIX) 

This  specimen  is  a mummified  head,  with  most  of  the  scalp  and  facial 
integument  and  some  of  the  hair  remaining.  The  mature  development 
of  the  teeth  and  the  condition  of  the  small  portion  of  the  sutures  visi- 
ble indicate  maturity;  the  hair  is  not  gray.  The  tendons  are  well 
developed;  the  skull  is  thinner  than  the  average  for  the  collection, 
measuring  about  3 mm.  at  the  point  of  operation. 

The  single  incomplete  operation  displayed  by  the  specimen  is  remark- 
ably instructive.  It  was  located  by  a depressed  fracture  in  the  left  side 
of  the  frontal  bone,  centering  45  mm.  above  the  orbit,  and  extending 
just  to  the  coronal  suture;  in  this  fracture  a section  of  both  tables  15 
by  20  mm.  was  forced  inward,  hinging  at  the  left,  but  completely 


BUREAU  OF  AMERICAN  ETHNOLOGY 


SIXTEENTH  ANNUAL  REPORT  PL.  XXVI 


FOUR  CRANIA  PRESERVED  IN  MUSEUM  AT  CUZCO 


BUREAU  OF  AMERICAN  ETHNOLOGY 


SIXTEENTH  ANNUAL  REPORT  PL.  XXVII 


FOUR  CRANIA  PRESERVED  IN  THE  MUSEUM  AT  CUZCO 


MUNIZ— MC  GEE] 


OPERATION  ON  DEPRESSED  FRACTURE 


41 


severed  on  the  lower  side,  around  the  median  end,  and  part  of  the  way 
around  the  upper  margin;  this  tongue  of  bone  is  itself  indented  and 
warped,  evidently  by  the  force  of  the  blow  producing  the  fracture;  and 
two  fissures  partially  crossing  its  base  nearly  separate  it  from  the  unin- 
jured bone.  The  rupturing  of  the  inner  table  was  quite  as  complete  as 
that  of  the  outer;  the  inner  table  was  split  and  torn  apart  beneath  the 
depressed  tongue,  and  a sliver  15  mm.  long  and  10  mm.  wide  remains 
attached  at  the  lower  anterior  side  of  the  wound.  Apparently  a nar- 
row zone  of  the  outer  table  has  disappeared  from  this  portion  of  the 
wound,  since  the  depressed  tongue  is  1 or  2 mm.  narrower  than  the 
aperture;  and  the  an tero- superior  extremity  of  the  tongue  has  also  dis- 
appeared, leaving  a clear  aperture  of  about  5 by  10  mm.  In  general 
the  wound  is  more  extensive  on  the  inner  surface  of  the  cranium  than 
on  the  outer,  for,  as  is  usual  in  case  of  depressed  fracture,  the  margins 
are  undercut,  the  tables  separating  somewhat  on  the  diploe.  The 
features  of  this  wound  are  slightly  masked  by  the  marks  produced  in 
the  unfinished  operation. 

The  indubitable  features  of  the  operation  are  three  principal  inci- 
sions, with  a number  of  minor  scratches.  The  most  prominent  incision 
is  nearly  horizontal,  traversing  the  upper  part  of  the  wound;  it  is  30 
mm.  in  length  and  penetrates  both  tables  of  the  bone  for  a length  of 
10  mm.  immediately  above  the  wound.  Its  anterior  extremity  divides 
into  two  strong  and  several  feeble  scratches,  each  evidently  made  by  a 
single  moderately  sharp  point;  the  deeper  portions  are  V-shape  in  sec- 
tion, and  the  wall  of  the  incision  above  the  wound  shows  parallel  stri- 
ation,  as  if  ground  by  a rough  surface;  in  short,  the  incision  is  precisely 
such  as  would  be  produced  by  a rather  sharp  stone  knife  or  spear- 
head, worked  reciprocally  with  considerable  pressure,  and  the  asso- 
ciated scratches  are  such  as  would  almost  inevitably  be  produced  by 
the  slipping  of  such  an  instrument  in  the  hands  of  a clumsy  operator 
at  the  beginning  of  the  operation.  The  second  incision  starts  from 
the  anterior  extremity  of  the  first,  at  an  angle  of  about  60  degrees, 
and  skirts  the  lower  margin  of  the  fracture  for  half  its  length,  i.  e.,  for 
about  19  mm.  It  is  a minature  homologue  of  the  incisions  displayed  in 
cranium  1 and  other  specimens,  V-shape  in  section,  deepest  and  broad- 
est toward  the  middle,  narrowing  and  shallowing  to  mere  scratches  at 
the  extremities ; in  this  case,  too,  there  are  a few  scratches,  evidently  due 
to  the  slipping  of  the  instrument.  For  a length  of  5 or  6 mm.  it  enters 
the  diploe;  it  does  not  penetrate  the  inner  table.  The  third  incision 
crosses’  the  first  near  its  posterior  extremity,  at  an  angle  of  about  69 
degrees,  the  three  being  so  placed  as  to  describe  an  equilateral  triangle 
coinciding  with  the  anterior  third  of  the  fracture.  This  incision  is  11 
mm.  in  length,  projecting  6 mm.  beyond  the  first  incision  (which  itself 
projects  3 or  4 mm.  beyond  this,  though  not  clearly  shown  to  do  so  in 
the  reproduction).  It  penetrates  both  tables  of  the  skull  just  above  the 
wound,  and  termiuates  abruptly  at  the  fracture,  the  relations  being 


42 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


such  as  to  prove  conclusively  that  the  fracture  preceded  the  incision. 
In  this  case,  too,  there  are  irregular  scratches  about  the  extremity  of 
the  incision,  showing  slipping  of  the  tool.  The  terminus  of  a fourth 
incision  or  series  of  incisions  appears  near  the  anterior  extremity  of 
the  wound,  approaching  the  central  part  of  the  second  incision.  These 
deep  scratches  were  apparently  made  on  a hinged  fragment  of  the  bone 
connecting  this  part  of  the  skull  with  the  principal  depressed  tongue; 
and  it  is  evident,  first,  that  they  were  not  made  until  after  the  fracture, 
and,  second,  that  a fragment  of  bone  has  disappeared  since  they  were 
made.  In  addition  to  these  definite  incisions,  there  is  a shallow  cut  or 
scratch  15  mm.  long,  nearly  parallel  with  the  second  incision,  extend- 
ing from  the  anterior  extremity  of  the  wound  toward  the  median  line; 
it  is  indistinctly  shown  in  plate  xxix. 

It  is  noteworthy  that  the  bone  was  stained  and  the  periosteum  modi- 
fied over  a tract  considerably  larger  than  that  of  the  fracture  (though 
this  is  not  clearly  indicated  in  the  reproduction).  On  the  lower  side  of 
the  wound  this  tract  is  not  clearly  defined,  though  its  margin  seems  to 
be  close  to  that  of  the  fracture;  but  on  the  upper  and  posterior  sides 
it  forms  a zone  10  to  15  mm.  wide,  semicircum scribing  the  wound.  This 
feature  is  especially  significant  in  connection  with  the  local  discolora- 
tion and  modification  of  several  other  crania,  notably  1,  2,  and  5.  It 
would  appear  to  represent  extension  of  the  injury  to  the  soft  tissue, 
perhaps  resulting  in  periostosteitis,  or  death  and  exceptionally  rapid 
post-mortem  decomposition  in  advance  of  mummification. 

The  sequence  of  events  and  movements  in  the  history  of  the  case  is 
indicated  by  this  specimen  with  considerable  clearness  and  certainty. 
It  is  evident  that  the  first  event  was  the  production  of  the  wound  by 
impact  of  a hard  object  (perhaps  a sling  stone  or  club  spike).  It  seems 
probable  that  several  hours  then  passed  without  treatment,  during 
which  local  inflammation  developed  and  extended  to  the  periosteum. 
Then  the  operation  was  commenced,  apparently  by  opening  the  scalp 
and  laying  bare  the  bone  (since  otherwise  the  subsequent  removal  of 
bony  splinters  could  hardly  have  taken  place).  Then  it  would  appear 
that  a short  incision  (the  fourth  of  the  foregoing  description)  was  made, 
whereby  one  or  two  fragments  of  bone  were  liberated  and  removed 
from  the  anterior  and  lower  margins  of  the  wound.  Then  the  principal 
incision  skirting  the  upper  side  of  the  wound  was  made,  and  another 
splinter  partly  liberated;  and,  to  dissever  this  splinter,  the  short  inci- 
sion above  the  depressed  tongue  was  then  produced,  when  the  frag- 
ment was  broken  out  by  means  of  an  elevator,  leaving  a small  irregular 
projection  of  the  inner  table  just  beneath  the  intersection  of  the  two 
incisions.  It  would  appear  that  the  anterior  incision  was  then  started 
for  the  purpose  of  removing  the  rough  edges  of  the  bone  and  giving 
access  to  the  conspicuous  sliver  of  the  inner  table  at  the  lower  side 
of  the  fragment.  This  incision  was  soon  abandoned,  and  the  opera- 
tion discontinued.  There  is  nothing  to  indicate  whether  the  scalp  was 


BUREAU  OF  AMERICAN  ETHNOLOGY 


SIXTEENTH  ANNUAL  REPORT  PL.  XXVIII 


ANTERIOR  ASPECT  OF  CRANIUM  14,  FROM  HUAROCHIRI 


I 


BUREAU  OF  AMERICAN  ETHNOLOGY 


SIXTEENTH  ANNUAL  REPORT  PL.  XXIX 


LEFT  LATERO-ANTERIOR  ASPECT  OF  CRANIUM  14 


MUNIZ — MC  GEE] 


OPERATION  ON  DEPRESSED  FRACTURE 


43 


restored,  and  everything  to  indicate  that  death  supervened  about  this 
stage. 

It  may  be  observed  that  this  specimen  displays  decided  facial  distor- 
tion, the  mouth,  nose,  and  tongue  being  strongly  drawn  toward  the 
right.  Whether  this  distortion  was  in  any  way  connected  with  the 
wound  or  the  operation  is  an  interesting  question,  but  one  that  need 
not  be  pursued  for  the  present,  since  it  would  seem  impossible  to  arrive 
at  certain  or  useful  results. 


Cranium  15 

(. Plates  XXX-XXXII) 

The  specimen  is  in  excellent  condition,  the  bones  being  perfectly  pre- 
served, and  a considerable  part  of  the  scalp  and  other  tissues  remaining. 
The  skull  is  strong,  with  the  usual  rugose  attachments.  Its  thickness 
varies  from  3 b to  5 mm.  about  the  single  artificial  aperture.  The  teeth 
are  only  fairly  mature  and  anchylosis  of  the  sutures  is  but  moderately 
advanced,  indicating  that  the  individual  died  in  his  prime. 

The  incomplete  operation,  which  reveals  the  methods  of  the  operator 
with  gratifying  clearness,  was  located  by  a fracture  near  the  posterior 
angle  of  the  left  parietal,  extending  to  within  15  mm.  of  the  sagittal  and 
lambdoid  sutures.  The  initial  wound  depressed  a tract  of  bone  about 
47  mm.  long  and  rather  over  20  mm.  wide,  measured  on  the  outer  table. 
Toward  the  sagittal  suture  and  along  the  lower  margin  the  inner  table 
is  undercut  2 to  5 mm.  The  indications  are  that  the  bone  was  com- 
pletely severed  more  than  halfway  around  the  oblong  aperture,  remain- 
ing hinged  at  the  upper  and  anterior  margins.  In  addition  the  outer 
table  was  cracked  concentrically  with  the  central  part  of  the  wound, 
parallel  with  the  upper  margin  and  some  10  mm.  from  it,  as  shown 
clearly  in  plate  xxxii.  The  instrumentation  comprised  three  definite 
incisions.  The  most  conspicuous  of  these  is  an  approximately  recti- 
linear cut  37  mm.  long,  skirting  the  upper  part  of  the  fracture  and 
penetrating  the  inner  table  for  a distance  of  12  mm.  The  projecting 
extremities  are  of  the  usual  V-shape  section  and  termination,  and  longi- 
tudinal strife  appear  in  the  remaining  wall  of  the  incision,  showing  that 
the  instrument  was  of  the  kind  indicated  in  other  operations.  The 
second  incision  in  extent  describes  the  upper  and  posterior  side  of  the 
aperture,  originating  near  the  extremity  of  the  first  incision.  It  is  27 
mm.  long,  extending  somewhat  farther  in  a narrow  scratch,  and  pene- 
trating the  inner  table  for  5 or  G mm.  near  its  anterior  termination. 
The  third  incision  describes  a part  of  tbe  anterior  margin  of  the  aper- 
ture, crossing  the  extremity  of  the  principal  incision.  It  is  about  20 
mm.  long,  but  extended  farther  on  the  tongue  of  bone  subsequently 
removed.  A few  shallow  cuts  are  placed  obliquely  to  this  incision, 
originating  at  the  intersection  of  this  with  the  first  incision  and  extend- 
ing directly  downward.  These  marks  appear  to  represent  a prelimi- 
nary or  exi>loratory  cutting,  which  was  abandoned  when  the  deeper 


44 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH  ANW.  16 


and  approximately  parallel  incision  was  outlined.  In  addition  there 
are  several  shallow  notches  in  the  lower  margin  of  the  aperture  near 
the  anterior  extremity,  evidently  made  by  striking'  the  instrument 
against  the  outer  table  while  sawing  across  the  base  of  the  depressed 
tongue,  either  in  making  the  third  incision  or  (more  probably)  in  making 
a nearly  parallel  incision  traversing  the  tongue  in  a somewhat  more 
nearly  horizontal  direction.  All  of  the  incisions  and  scratches  were 
apparently  made  by  the  same  tool. 

The  sequence  represented  by  the  operation  is  indicated  with  consid- 
erable clearness.  Initially  there  was  a large  depressed  fracture  with 
some  adjacent  cracking  of  the  bone,  the  principal  depressed  tract  being 
in  the  form  of  a tongue  hinged  at  the  anterior  and  upper  sides,  but  com- 
pletely severed  more  than  halfway  around.  Three  or  more  incisions 
were  made  in  such  manner  as  to  divide  the  hinge,  and  in  making  a 
part  of  them  the  tool  was  reciprocated  on  the  depressed  bone  in  such 
manner  as  to  leave  its  marks  on  the  free  margin.  When  the  incisions 
were  fairly  advanced,  an  elevator  was  used  and  the  depressed  tongue 
was  forced  out,  leaving  projecting  edges  of  the  inner  table  on  the  upper 
margin,  and  this  operation  was  performed  with  such  vigor  that  the 
anterior  portion  of  the  hinge  passed  beyond  the  nearly  vertical  incision 
aud  invaded  the  uninjured  bone,  breaking  through  both  tables  and 
leaving  the  inner  projecting  beyond  the  outer.  At  this  point  the  oper- 
ation was  discontinued,  presumptively  by  reason  of  the  death  of  the 
victim ; the  rough  edges  were  not  smoothed,  and  there  is  not  the  slight- 
est trace  of  subsequent  growth — indeed,  the  invasion  of  the  cerebral 
tissues  by  the  tip  of  the  clumsily  applied  instrument  would  have  been 
almost  necessarily  fatal.  In  this  specimen  there  is  no  indication  of 
local  inflammation. 

Taken  together,  crania  II  aud  15  appear  to  represent  somewhat  dif- 
ferent stages  in  precisely  parallel  operations.  In  cranium  14  the  treat- 
ment was  abandoned  after  the  removal  of  a few  fragments  aud  splinters 
of  bone,  but  before  the  removal  of  the  principal  tongue,  while  in 
cranium  15  it  was  abandoned  immediately  after  removing  the  tongue  or 
button. 

Cranium  15  displays  the  vertical  grooves  over  the  temples,  one  on 
either  side,  with  a few  smaller  marks.  In  addition  there  is  a prominent 
scar  of  a practically  healed  wound  a little  to  the  left  of  the  center  of 
the  upper  margin  of  the  frontal  bone.  The  wound  was  evidently  pro- 
duced by  a blow  from  a rather  blunt  edge,  transverse  to  the  median 
line,  directed  downward  and  forward  so  as  to  glance  forward;  the  bone 
is  indented  and  bruised,  forming  a transverse  trough  (15  mm.  below 
the  coronal  suture)  5 or  6 mm.  broad  and  17  mm.  long;  below,  the  bone 
bulges  slightly,  and  the  lower  side  of  the  ridge  is  partly  defined  by 
a curved  fracture  of  the  outer  table  18  mm.  long.  The  edges  of  the 
fracture  are  knit,  and  there  are  other  indications  that  the  wound 
was  practically  recovered  before  death. 


BUREAU  OF  AMERICAN  ETHNOLOGY 


SIXTEENTH  ANNUAL  REPORT  PL.  XXX 


SUPERIOR  ASPECT  OF  CRANIUM  15,  FROM  HUAROCHIRI 


BUREAU  OF  AMERICAN  ETHNOLOGY  ' \ SIXTEENTH  ANNUAL  REPORT  PL.  XXX( 


LEFT  LATERAL  ASPECT  OF  CRANIUM  15 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXXII 


LEFT  LATERO-POSTERO-SUPERIOR  ASPECT  OF  CRANIUM  15 


MUNIZ — MC  GEE] 


OPERATION  ON  LINEAR  FRACTURE 


45 


Cranium  10 

{Plates  XXXII  l,  XXXIV ) 

This  is  a mummified  head,  in  excellent  condition  for  examination, 
and  of  special  interest  in  that  it  reveals  in  part  the  incisions  through 
the  scalp  made  in  connection  with  the  principal  operation.  The  skull 
is  one  of  the  largest  of  the  series,  with  the  customary  rugose  attach- 
ments and  stout  tendons.  The  teeth  are  fairly  mature  (the  left  poste- 
rior molar  is  lacking),  indicating  early  maturity.  In  addition  to  the 
lesions  connected  with  the  operation,  there  is  a deep  scratch  on  the  left 
side  of  the  frontal  bone,  extending  from  32  to  57  mm.  above  the  orbit, 
and  an  extensive  scar,  some  30  mm.  wide  by  5<>  high,  on  the  right  side 
of  the  same  bone,  extending  from  the  coronal  suture  halfway  to  the 
orbit,  together  with  a few  minor  scratches;  all  of  these  marks  appar- 
ently recording  recovered  wounds. 

The  complex  and  elaborate  operation  was  located  by  an  extensive 
wound,  chiefly  a linear  fracture,  extending  from  the  median  line  of  the 
occipital  through  the  lower  angle  of  the  right  parietal  to  the  temporo- 
parietal suture,  along  this  suture  for  20  mm.,  thence  obliquely  down- 
ward through  the  temporal  bone  to  a point  just  within  the  zygoma, 
and  thence  upward  and  forward  entirely  across  the  temporal  bone  and 
half  way  to  the  margin  of  the  left  orbit;  the  fracture  being  155  mm.  in 
length  measured  directly  on  the  surface  of  the  skull,  and  about  200  mm. 
measured  along  its  meandering  course.  The  incision  in  the  scalp  began 
in  the  center  of  the  back-head,  and  was  carried  well  down  over  the 
occipital  to  a point  apparently  somewhat  below  the  extremity  of  the 
fracture,  and  thence  along  the  fracture  to  a point  on  the  temporal  bone 
near  the  posterior  margin.  The  tissues  were  then  apparently  pushed 
aside  and  crumpled  into  irregular  masses,  that  on  the  right  of  the 
incision  being  particularly  thick.  Work  was  then  begun  on  the  bone, 
apparently  in  random  fashion;  it  would  seem  probable  that  the  first 
incisions  were  the  three  nearly  vertical  cuts  in  the  occipital.  The  deep- 
est of  these  is  about  37  mm.  in  length,  and  is  carried  into  the  diploe 
without  penetrating  the  inner  table.  It  is  oblique  V-shape  in  cross- 
section,  with  the  usual  attenuated  extremities,  the  lower  revealing  a 
number  of  scratches.  Parallel  with  it  is  a shallow  incision  of  similar 
character,  22  mm.  long  and  perhaps  2 mm.  deep,  not  penetrating  the 
outer  table.  Nearly  parallel  with  these  is  a similar  incision  35  mm.  long 
and  3 mm.  deep,  just  penetrating  the  outer  table  in  its  center.  The 
upper  extremity  curves  rather  sharply  to  the  left  (though  this  does  not 
clearly  appear  in  plate  xxxiv),  while  the  lower  extremity  divides  into 
deep  scratches  of  the  usual  character,  also  veering  toward  the  left. 
There  is  no  indication  that  these  deflections  toward  the  extremities  of 
the  incision  were  intentional,  and  everything  to  indicate  that  they  rep 
resented  a series  of  slips  of  the  tool  occasioned  by  inequalities  in  the 
surface  of  the  bone.  Evidently  these  incisions  were  exploratory,  and 


46 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


were  abandoned;  since  the  last  described  just  intersects  the  extremity 
of  the  fracture,  which  it  might  have  revealed  to  the  operator,  it  seems 
probable  that  the  line  of  exploration  was  then  turned  toward  the  right 
along  the  fracture.  Thirty-five  mm.  from  the  last  incision  there  is  an 
irregularly  circular  aperture,  averaging  9 or  10  mm.  in  diameter,  pro- 
duced by  scraping.  This  process  extended  over  an  area  25  or  30  mm. 
across,  over  most  of  which  the  outer  table  and  diploe  are  removed  and 
the  inner  table  reduced  to  paper-like  thinness.  Thence  a series  of 
scratches  and  strife,  as  if  produced  by  scraping  with  a rather  blunt  tip 
or  grinding  with  an  irregularly  rough  surface,  follow  the  fracture  to 
and  a little  way  across  the  lambdoid  suture.  At  the  intersection  of  the 
fracture  with  this  suture  the  bone  is  gouged  and  scraped  to  a depth  of 
4 or  5 mm.,  or  through  the  outer  table  and  diploe.  Thence  several  nar- 
row scratches  pass  horizontally  across  the  lower  portion  of  the  parietal, 
terminating  about  the  temporo-parietal  suture,  beyond  which  the  oper- 
ation seems  not  to  have  been  carried  (these  scratches  are  but  indis- 
tinctly shown  in  the  reproduction,  plate  xxxm). 

The  sequence  of  events  and  movements  in  the  case  may  be  deter- 
mined from  the  specimen  with  considerable  certainty.  The  initial  inci- 
dent was  apparently  a blow  or  shock  producing  the  linear  fracture ; and, 
while  there  is  some  doubt  as  to  the  character  of  the  shock,  and  also  as 
to  the  point  of  impact  assuming  it  to  have  been  a blow,  it  seems  probable 
that  the  wound  centered  about  the  intersection  of  the  fracture  with  the 
lambdoid  suture,  where  the  bone  is  depressed  and  where  the  character 
of  the  subsequent  operation  suggests  that  the  outer  table  was  crushed ; 
and  the  fracture  appears  to  be  such  as  might  have  been  produced  by  a 
violent  blow  at  this  point.  It  seems  certain  that  this  wound  antedated 
the  incision  in  the  scalp,  and  that  this  incision  was  largely  exploratory, 
since  it  was  inaccurately  located ; and  it  seems  probable  that  in  the 
early  stages  the  operation  on  the  bone  was  random.  In  like  manner  it 
seems  certain  that  the  operation  was  abandoned  incomplete;  for  not 
only  is  there  no  indication  of  finish  in  the  work  on  the  bone,  but  the 
scalp  remained  open  when  the  victim  was  transferred  from  the  pre- 
sumptive battlefield  to  the  cemetery;  it  is  certain  that  he  did  not 
survive. 

On  the  whole  it  appears  impossible  to  regard  the  operation  displayed 
by  this  specimen  in  any  other  light  than  as  a crude,  clumsy  attempt, 
with  rude  tools,  to  explore  or  perhaps  to  treat  a serious  wound;  and  it 
is  unquestionable  that  either  the  initial  wound  or  the  treatment  proved 
fatal  before  the  operation  was  complete.  It  can  not,  of  course,  be  con- 
sidered certain  that  the  operation  was  not  early  post-mortem,  but  there 
is  absolutely  nothing  to  indicate  this  date;  and  not  even  the  lowliest 
mind  could  have  designed  the  cuts  and  scratches  displayed  by  the  bone 
for  the  purpose  of  obtaining  portions  of  the  skull  for  amulets  or  for  any 
purpose.  There  is,  of  course,  a possibility  that  the  operation  represents 
a post-mortem  examination;  but  there  is  neither  evidence  nor  presump- 
tion in  favor  of  this  supposition. 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REFORT  PL  XXXIII 


RIGHT  LATERAL  ASPECT  OF  CRANIUM  16,  FROM  HUAROCHIRI 


SIXTEENTH  ANNUAL  REPORT  PL.  XXXIV 


POSTERO-INFERIOR  ASPECT  OF  CRANIUM  16 


MUNIZ— MC  GEE] 


OPERATION  ON  STELLATE  FRACTURE 


47 


Cranium  17 

(Plates  XXXV,  XXXVI) 

This  is  a mummified  head,  with  the  scalp  remaining  on  the  right  side 
back  of  the  coronal  suture  and  over  half  of  the  occiput,  while  shreds 
of  tissue  remain  elsewhere;  the  bones  are  perfectly  preserved  and  fatty 
throughout.  The  skull  is  hardly  so  thick  and  strong  as  the  average  of 
the  collection,  though  the  attachments  are  rugose.  The  teeth  are  well 
developed  (the  left  posterior  molar  is  lacking)  and  the  sutures  fairly 
united,  indicating  rather  early  maturity;  two  interparietal  bones  (the 
smaller  clearly  shown  in  plate  xxxv)  interrupt  the  lambdoid. 

The  specimen  displays  a wound  and  two  or  three  associated  opera- 
tions on  the  left  side.  The  wound  is  an  irregular  splintered  fracture, 
apparently  centering  just  below  a point  about  midlength  of  the  tem- 
poro-parietal  suture,  and  30  or  35  mm.  above  the  auricular  meatus. 
The  principal  fissure  traverses  the  temporal  bone,  as  shown  in  plate 
xxxv,  and  can  be  traced  in  the  auricular  openiug  fully  30  mm. ; a curvi- 
linear crack  some  30  mm.  in  length  crosses  this  fissure  at  a large  angle 
12  mm.  above  the  origin  of  the  zygoma,  dying  out  anteriorly  but 
extending  to  the  suture  posteriorly;  the  third  line  of  fracture  evidently 
coincided  with  the  suture  for  a distance  of  some  40  mm.;  and  a fourth 
apparently  defined  the  lower  margin  of  the  irregular  aperture  for  a 
length  of  somewhat  over  30  mm.  In  addition  there  are  traces  of 
another  radial  fissure  extending  upward  and  backward  from  the  cen- 
tral poiut  for  a distance  of  35  mm.;  it  defines  the  upper  margin  of  the 
triangular  fragment  loosened  by  the  curvilinear  crack  and  the  fracture 
along  the  suture,  divides  the  bridge  of  bone  below  the  circular  aper- 
ture, aud  appears  in  the  specimen  (and  faintly  in  the  reproduction)  on 
the  upper  posterior  side  of  this  aperture.  About  the  center  of  the 
wound  the  boue  is  considerably  depressed. 

There  were  three  measurably  distinct  operations  evidently  located 
by  the  wound.  The  principal  operation  was  that  represented  by  the 
approximately  circular  aperture,  which  averages  19  mm.  in  diameter. 
All  about  this  openiug  traces  of  instrumentation  appear.  The  bone  is 
striated  in  various  directions,  but  for  the  most  part  concentrically 
about  the  aperture,  showing  that  the  operation  was  finished  by  scrap- 
ing or  rasping,  though  whether  with  or  Avithout  antecedent  incisiou 
and  elevation  can  not  certainly  be  determined.  On  the  posterior  side 
the  bone  is  scraped  quite  thin,  though  on  the  anterior  side  most  of  the 
thickness  of  the  inner  table  forms  the  margin  and  is  cut  through  in 
a nearly  vertical  direction,  showing  that  here  at  least  there  was  curv- 
ilinear cutting,  perhaps  subsequent  to  the  scraping.  The  general 
appearance  of  the  opening  and  margins  suggests  that  the  operation 
was  completed  to  the  satisfaction  of  the  operator;  but  the  absence  of 
reparative  growth  and  the  distinct  preservation  of  the  stria?  produced 
by  rasping  prove  that,  the  victim  did  not  long  survive. 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


48 


The  second  aperture  would  seem  to  have  been  produced  by  a single 
operation,  probably  subsequent  to  the  principal  one.  It  was  evidently 
begun  by  a rectilinear  incision  of  the  usual  character,  commencing’  at 
a point  over  the  temporo-parietal  suture  (subsequently  removed  by 
the  conspicuous  canoe-shape  incision)  and  below  the  main  aperture,  and 
extending  thence  forward  at  least  15  mm.  to  the  main  vertical  fissure 
and  probably  somewhat  farther.  It  was  not  carried  through  the  bone. 
There  are  indications  that  when  the  bone  was  weakened  by  this  incision, 
an  elevator  was  used  to  break  out  two  or  more  fragments,  thus  pro- 
ducing the  triangular  aperture.  Jagged  projections  of  the  inner  por- 
tion of  the  bone  remained  and  were  not  removed,  but  the  outer  edges 
were  smoothed  by  rasping  or  scraping. 

The  next  operation  or  step  produced  a single  rectilinear  incision  35 
mm.  in  length,  5 mm.  wide  at  the  center  measured  on  the  outer  surface, 
of  the  usual  V-shape  section  and  terminations,  penetrating  the  bone  for 
a length  of  11  mm.  and  a width  of  2 mm.  at  the  center,  thus  indicating 
that  the  instrument  invaded  the  intracranial  tissues  and  probably 
brought  the  trials  of  the  victim  to  an  end. 

In  addition  to  these  definite  operations  there  are  several  significant 
scratches,  apparently  exploratory.  The  most  conspicuous  are  three  or 
four  parallel  cuts,  the  longest  25  mm.  in  length,  extending  upward  and 
backward  from  a point  10  mm.  beyond  the  postero- superior  margin  of 
the  principal  aperture,  in  a direction  approximately  parallel  with  the 
radial  fracture  removed  in  making  this  aperture  (the  principal  scratch 
of  this  series  appearing  in  plate  xxxv).  Appearances  indicate  that 
these  scratches  originally  extended  farther  downward  and  forward,  and 
that  their  extremities  were  obliterated  by  the  subsequent  rasping.  A 
single  scratch  extends  almost  directly  backward  from  a point  15  mm. 
back  of  the  main  aperture  for  a distance  of  G or  7 mm.,  almost  inter- 
secting the  upper  extremity  of  a rough  groove  extending  downward 
17  mm.,  and  crossing  the  posterior  extremity  of  the  principal  rectilinear 
cut.  Two  rather  conspicuous  grooves  appear  downward  and  forward 
from  the  circular  aperture;  the  more  definite  extends  from  the  bridge 
below  this  aperture  backward  to  the  center  of  the  main  rectilinear 
incision.  Along  the  suture  below  this  incision  there  are  conspicuous 
transverse  scratches  produced  by  scraping,  rasping,  or  grinding  with 
a rough  edge  or  surface;  and  similar  marks  cross  the  curvilinear  crack 
forward  to  the  origin  of  the  zygoma,  where  they  unite  with  the  striae 
connected  with  the  main  operation.  The  most  remote  traces  of  instru- 
mentation are  two  parallel  cuts  in  the  bone  just  below  the  temporo 
parietal  suture,  10  mm.  from  its  union  with  the  lambdoid.  (Only  one 
of  these  marks  appears  in  the  reproduction.) 

The  indications  of  sequence  in  the  operation  are  somewhat  indefinite, 
though  it  seems  certain  that  the  instrumentation  succeeded,  and  was 
located  by,  the  wound.  It  would  appear  that  on  dividing  and  pushing 
aside  the  scalp  (after  the  manner  indicated  by  cranium  16),  the  operator 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXXV 


LEFT  LATERAL  ASPECT  OF  CRANIUM  17,  FROM  TARMA 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXXVI 


ANTERIOR  ASPECT  OF  CRANIUM  17 


MUNIZ—  MC  GEE] 


OPERATION  REPEATED  OR  CONTINUED 


49 


explored  the  bone  extensively,  and  finally  located  the  uppermost  radial 
fissure,  and  proceeded  to  develop  the  principal  aperture,  completing  the 
operation  by  grinding  down  the  sharp  edges.  It  seems  probable  that 
shortly  afterward,  perhaps  within  a few  hours,  exploration  was  extended 
toward  the  center  of  the  wound  so  far  as  to  reveal  the  fracture  follow- 
ing the  temporo  parietal  suture  and  the  transverse  fissure  across  the 
temporal  bone,  and  that  rude  cutting  and  elevating  followed  in  such 
manner  as  to  produce  ihe  irregularly  triangular  aperture  and  widen  the 
opening  through  the  bridge  separating  it  from  the  circular  aperture. 
Remniuits  of  tissue  clinging  to  the  bone  below  the  second  aperture  and 
still  covering  the  anterior  extremity  of  the  curvilinear  track  indicate 
that  the  scalp  and  upper  portion  of  the  ear  were  not  laid  back  much 
below  the  point  of  impact  on  or  near  the  suture ; and  there  are  indica- 
tions that  at  this  stage  the  exploration  was  diverted  and  carried  down- 
ward and  backward  across  the  curvilinear  fissure  and  thence  along 
the  posterior  portion  of  the  suture,  and  this  work  seems  to  have  beeu 
followed  by  the  scratching  or  rasping  transverse  to  the  lines  of  fracture. 
Undoubtedly  the  last  important  step  in  the  operation  or  series  of  opera- 
tions was  the  development  of  the  canoe-shape  incision,  wdiich  cuts  across 
and  interrupts  or  terminates  the  strim  and  incisions  produced  in  the 
earlier  work;  this  was  apparently  the  first  step  in  a projected  operation 
of  greater  extent,  which  was  carried  no  further,  presumptively  by  tea- 
son  of  the  death  of  the  patient,  which  must  have  been  hastened,  or  even 
produced,  by  the  clumsy  invasion  of  the  meninges  in  the  central  part  of 
the  incision.  It  is  barely  possible,  though  by  no  means  probable,  that 
the  period  intervening  between  the  completion  of  the  principal  opera- 
tion and  the  beginning  of  the  incomplete  treatment  was  of  considerable 
duration  and  that  the  two  were  not  connected  with  the  same  wound. 
There  is  nothing  to  indicate  that  any  part  of  the  operation  was  post- 
mortem, while  the  abandonment  of  cutting  at  an  evidently  initial  stage 
in  an  extensive  operation  seems  explicable  only  on  the  supposition  that 
it  resulted  from  death  under  the  kuife. 

In  addition  to  the  lesions  about  the  wound,  the  cranium  reveals  an 
old  wound  in  the  form  of  a deep  scratch  or  groove  toward  the  right 
margin  of  the  frontal  bone,  nearly  parallel  with  the  coronal  suture, 
extending  upward  25  mm.  from  a point  55  mm.  above  the  outer  margin 
of  the  orbit. 

Cranium  18 

( Plates  XXXVII , XXXVIII ) 

This  skull  is  excellently  preserved,  having  been  taken  from  a mummi- 
fied skeleton,  though  fleshy  tissues  are  absent  save  for  shreds  in  some 
of  the  cavities.  It  is  quite  thick  and  strong,  with  remarkably  developed 
and  rugose  attachments.  The  bones  average  6 or  7 mm.  in  thickness 
about  the  three  apertures.  The  teeth  are  fairly  mature,  and  the  union 
of  the  sutures  is  well  advanced,  indicating  middle  age. 

1G  eth 4 


50 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


The  specimen  displays  three  extensive  operations  of  different  dates, 
without  trace  of  antecedent  lesion  in  any  case.  The  earliest  operation 
was  located  in  the  upper  portion  of  the  left  parietal,  adjacent  to  the 
sagittal  suture,  centering  about  60  mm.  back  of  the  coronal;  it  resulted 
in  a rudely  circular  aperture  now  measuring  29  mm.  in  longest  diameter. 
Save  that  the  margins  are  beveled  from  without,  no  trace  of  instrumen- 
tation remains:  the  beveled  surface  has  assumed  the  texture  normal  to 
the  exterior  of  the  cranium  save  for  radial  lines  of  reparative  growth, 
increasing  in  strength  toward  the  edges  of  the  aperture.  Many  strong 
spicules  and  knobs  of  new  bone  project  from  the  margin,  sometimes 
so  much  as  3 or  4 mm.  into  the  opening,  while  the  diploe  is  completely 
obliterated.  The  extent  of  reparative  process  indicates  that  the  patient 
survived  the  operation  for  years. 

The  second  operation  centered  45  mm.  below  the  first,  i.  e.,  near  the 
posterior  angle  of  the  left  parietal,  about  42  mm.  from  the  sagittal 
suture  and  35  mm.  from  the  middle  line  of  the  lambdoid.  It  resulted 
in  a-  rudely  circular  aperture  now  about  25  mm.  in  mean  diameter,  in  every 
respect  comparable  with  that  of  the  first  operation,  save  that  the  rep- 
arative modification  of  the  bone  is  less  advanced,  especially  about  the 
upper  margin  or  toward  the  antecedent  opening.  The  beveled  surface 
shows  ridges  of  growth,  but  otherwise  approximates  the  aspect  of 
the  normal  bone,  and  appearances  indicate  that  the  periosteum  was 
developed  over  it  in  quite  the  normal  manner.  The  diploe  is  almost 
wholly  obliterated,  though  it  can  be  detected  about  the  antero-inferior 
margin  of  the  aperture  and  also  toward  the  junction  of  the  sagittal  and 
lambdoid  sutures.  While  spicular  growth  is  in  general  less  developed 
than  about  the  earlier  aperture,  it  is  particularly  well  displayed  about 
the  inferior  margin,  where  the  spicules  are  at  least  2 or  3 mm.  in  length 
and  sometimes  branch  or  divide  into  lateral  spicules  toward  the  extrem- 
ity. There  can  be  no  doubt  that  the  individual  survived  this  operation 
also  for  some,  probably  several,  years,  and  it  is  possible  that  the  two 
were  performed  about  or  (just  possibly)  at  the  same  date. 

The  third  operation  was  located  in  the  crown,  involving  the  coronal 
suture,  and  traversing  the  sagittal  suture  near  its  anterior  extremity. 
In  this  case  fairly  definite  traces  of  instrumentation  appear.  The 
clearest  marks  are  of  such  character  as  to  indicate  that  they  were 
produced  by  curvilinear  incision  effected  through  the  use  of  a blunt 
single-point  instrument  wielded  by  a vigorous  hand;  and  they  are  so 
related  in  position  as  to  suggest  that  the  operator  (being  right-handed 
though  somewhat  ambidextrous)  sat  on  a low  bench  or  bank,  holding 
the  head  of  the  patient  (lying  supine  and  facing  in  the  same  direction 
as  the  operator)  somewhat  inclined  forward  between  his  knees;  that  he 
then  began  a curvilinear  incision  on  the  right  side,  swinging  his  hand 
strongly  toward  the  left  at  the  forward  end  of  the  stroke  as  the  cut 
was  extended  and  deepened;  and  that  he  gradually,  with  the  use  of 
the  left  hand  or  both  together,  carried  the  incision  around  to  the  left 
and  then  toward  himself,  in  such  manner  as  to  describe  an  inverted  U or 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXXVII 


SUPERIOR  ASPECT  OF  CRANIUM  18,  FROM  CUZCO  (TRIPLE-TREPHINED) 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXXVIII 


LEFT  LATERAL  ASPECT  OF  CRANIUM  18 


MUNIZ — MC  GEE] 


THREE  DISTINCT  OPERATIONS 


51 


(more  exactly)  a horseshoe.  In  tlie  earlier  part  of  the  cutting  the  knife 
apparently  slipped  occasionally,  particularly  toward  the  heel  extrem- 
ities, though  as  the  incision  deepened  care  was  taken  to  bring  these 
extremities  nearer  together.  Finally,  it  would  appear  that  the  points 
of  the  incision  were  connected  by  a transverse  cut,  slightly  curved, 
made  with  the  right  hand,  slightly  oblique  to  the  axis  of  the  horseshoe, 
as  determined  by  convenience  of  movement,  whereby  the  aperture  was 
defined.  Throughout  the  instrument  was  held  obliquely,  the  obliquity 
increasing  with  the  depth  in  such  manner  that  the  aperture  measures 
considerably  larger  on  the  exterior  surface  than  on  the  interior,  while 
the  profile  of  the  cut  surface  is  slightly  concave.  The  aperture  averages 
about  33  mm.  in  diameter  without,  and  a little  over  20  within.  It  appears 
rather  probable  that  an  elevator  was  used  before  the  inner  table  was 
penetrated,  and  that  the  outer  table  was  removed  separately,  affording 
greater  freedom  in  extending  the  incisions  through  the  inner  table. 
After  the  aperture  was  opened,  the  operation  was  completed  by  scrap- 
ing or  rasping  down  the  ragged  edges  produced  in  making  the  inci- 
sions and  smoothing  the  entire  margin  of  the  aperture,  evidently  with 
great  care,  in  such  manner  as  to  leave  a thin  projecting  edge  of  the 
inner  table  resting  on  the  intracranial  tissues.  In  this  final  operation 
the  deep  scratches  due  to  the  slipping  of  the  instrument  toward  the 
point  of  the  horseshoe-shape  incision  were  filed  out  into  broad  grooves, 
but  two  or  three  exploratory  scratches  forward  of  the  opening  were 
allowed  to  remain.  Thus  the  operation  was  completed,  evidently  to 
the  satisfaction  of  the  operator;  yet  it  is  doubtful  whether  the  patient, 
already  mature  or  perhaps  somewhat  advanced  in  age,  survived.  While 
there  are  no  clear  indications  of  reparative  process  on  the  surface  of  the 
bone,  and  no  unmistakable  growth  spicules,  the  diploe  seems  to  be  par- 
tially obliterated,  and  there  are  a few  salients  along  the  thin  projected 
margin  of  the  inner  table  which  suggest  secondary  growth.  On  the 
other  hand,  there  is  some  discoloration  of  the  skull  about  the  aperture, 
such  as  might  be  produced  by  localized  inflammation,  perhaps  develop- 
ing into  periostosteitis,  suggesting  that  while  the  patient  survived  the 
immediate  operation  the  sequelae  were  fatal.  It  may  be  observed  that 
this  great  aperture,  opening  almost  directly  over  an  important  sinus, 
violates  in  its  location  the  modern  rules  of  trephining,  and  could 
hardly  be  expected  to  eventuate  otherwise  than  in  the  death  of  the 
victim. 

Of  the  three  operations,  two  were  undoubtedly  long  ante-mortem, 
while  it  is  practically  certain  the  third  was  ante-mortem  also.  Although 
the  instrumentation  is  indicated  only  by  the  last  operation,  the  simi- 
larity in  form  in  the  three  apertures  suggests  that  all  were  performed 
in  essentially  the  same  way. 

Aside  from  the  operations,  there  are  several  indications  that  the 
individual  led  an  eventful  life;  there  is  a deep  contusion  near  the  center 
of  the  right  parietal  (shown  in  plate  xxxvn);  there  is  one  of  the  cus- 
tomary supraorbital  grooves  or  scratches  near  the  right  side  of  the 


52 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


frontal  bone  extending  32  mm.  upward  and  backward  from  a point 
34  mm.  above  the  outer  margin  of  the  right  orbit;  and  there  is  an 
irregular  contusion  in  the  frontal,  20  mm.  to  the  left  of  the  median  liue 
and  50  mm.  above  the  right  orbit. 

Cranium  19 
(. Plates  XXXIX , XL) 

This  specimen  is  the  smallest,  most  fragile,  and  most  delicately  molded 
in  the  collection;  the  bone  averages  2£  or  3 mm.  in  thickness  about  the 
single  immense  aperture.  It  was  found  invested  with  the  scalp,  ten- 
dons, and  other  tissues,  but  these  were  mostly  removed,  leaving  only 
occasional  shreds  clinging  to  the  bones,  particularly  in  the  cavities. 
The  ligament  attachments  are  better  developed  than  in  the  average 
Caucasiau  skull,  particularly  about  the  occiput,  though  less  rugose  and 
deeply  striated  than  in  most  of  the  specimens.  The  small  dimensions 
and  several  other  characters  suggest  femininity.  The  age  is  not  easily 
ascertained:  The  sutures  are  anchylosed  more  completely  than  in  any 
other  specimen  of  the  collection,  yet  the  dentition  is  quite  immature; 
the  anterior  molars  or  “seven-year  teeth”  are  barely  erupted,  and  evi- 
dently had  not  appeared  through  the  gums  at  the  time  of  death;  the 
“wisdom  teeth”  are  rudimentary,  being  visible  through  the  bone  some 
distance  (4  or  5 mm.  on  the  right  and  twice  as  much  on  the  left)  below 
the  surface;  moreover  the  mandible  is  short,  allowing  absolutely  no 
room  for  the  normal  eruption  of  these  teeth.  On  the  whole  the  cranium 
has  an  abnormal  aspect  in  several  respects.  In  addition  to  the  lesions 
appearing  about  the  locus  of  operation,  there  is  a pronounced  indenta- 
tion, with  some  crushing  and  bruising  of  the  bony  surface  on  the  left 
side  of  the  frontal  bone  25  mm.  from  the  median  line  and  40  mm.  above 
the  orbit  (shown  in  plate  xxxix);  it  partially  obliterates  one  of  the 
usual  vertical  grooves  over  the  temple.  A well  developed  “Inca  bone” 
replaces  the  superior  angle  of  the  occipital. 

The  remarkable  aperture  displayed  by  this  specimen  extends  from 
near  the  center  of  the  right  parietal  forward  and  downward  through 
the  frontal  to  a point  18  mm.  above  the  center  of  the  right  orbit;  it  is 
an  elongated  oval  or  ellipse  95  mm.  in  length  and  33  mm.  in  maximum 
width  measured  in  the  plane  of  the  margins,  or  about  35  by  105  mm. 
measured  on  the  curved  surface  of  the  skull.  Many  marks  ot  instru- 
mentation appear,  though  the  earlier  have  been  obscured  or  obliterated 
by  subsequent  scraping  or  tiling.  Perhaps  the  most  decisive  (which 
unfortunately  is  not  well  brought  out  in  the  reproduction)  is  a recti- 
linear incision  23  mm.  long  defining  the  antero-superior  margin  ot  the 
aperture,  of  which  the  terminal  portions  remain.  The  anterior  termi- 
nal, 6 mm.  in  length,  is  a groove  or  cut  of  the  usual  V-shape  section, 
though  more  rounded  than  usual  at  the  bottom,  about  1 mm.  in  width 
and  1.5  mm.  in  greatest  depth,  shallowing  and  narrowing  toward  the 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XXXIX 


ANTERIOR  ASPECT  OF  CRANIUM  19,  FROM  HUAROCHIRI 


MUNIZ— MC  GfiE] 


OPERATION  COMPLETED  WITH  PLATE 


53 


tip,  beyond  which  a narrow  scratch  extends  to  the  transverse  fracture 
limiting  the  aperture  anteriorly,  as  best  shown  in  plate  xxxix.  The 
medial  portion  of  this  incision  forms  the  margin  of  the  aperture  for 
10  mm.,  as  shown  by  both  illustrations,  especially  plate  xxxix,  though 
for  most  of  this  distance  it  was  not  carried  entirely  through  the  inner 
table,  a narrow  projection  of  which  remains.  The  posterior  terminal 
of  the  incision  is  somewhat  obscured  by  later  scraping,  yet  it  is  fairly 
definite  for  5 mm.  and  similar  to  the  better-preserved  anterior  extremity. 
Next  in  clearness  is  the  curvilinear  incision  marking  the  postero-mediau 
margin  of  the  aperture;  as  shown  by  its  conformation  and  by  longi- 
tudinal striae,  this  was  made  by  a rather  blunt-pointed  and  rough- 
sided instrument,  held  vertical  and  reciprocated  with  a curvilinear 
movement.  For  a length  of  some  15  mm.,  measured  around  the  curve, 
it  very  nearly  penetrated  the  inner  table,  leaving  a thin  projecting  edge 
of  bone,  as  clearly  shown  in  plate  XL;  thence  for  10  mm.  forward  it 
shallowed  in  such  manner  that,  when  the  elevator  was  used,  most  or 
all  of  the  thickness  of  the  inner  table  remained  after  the  button  was 
dissevered,  and  still  persists,  as  shown  in  both  reproductions.  Nearly 
as  decisive  as  these  cuts  is  the  rectilinear  incision  defining  the  lower 
side  of  the  aperture  from  the  coronal  suture  well  toward  the  posterior 
extremity,  a distance  of  about  35  mm.  Although  the  margin  of  the 
outer  table  has  been  ground  away,  one  side  of  this  incision  still  retains 
its  original  character,  and  the  bottom  of  the  cut  for  half  its  length  is 
shown  on  the  narrow  selvage  of  the  inner  table  left  to  be  broken  away 
when  the  button  was  lifted;  the  incision  was  of  the  usual  character,  as 
shown  by  conformation  and  strife,  indicating  that  it  was  made  with  an 
instrument  having  a single  blunt  point  and  rough  sides,  operated 
reciprocally.  The  entire  aperture  is  circumscribed  by  scratches  and 
strife  produced  in  smoothing  the  rough  edges  of  the  bone  left  by  the 
earlier  cutting;  yet  at  several  points  there  are  deeper  grooves  or  cuts, 
evidently  made  in  connection  with  ihe  main  incisions,  either  in  a ran- 
dom way  or  by  the  slipping  of  the  tool.  The  most  conspicuous  of  these 
' are  outside  the  better-rounded  posterior  extremity  of  the  aperture,  and 
several  are  in  such  position  as  to  show  the  effort  made  by  the  operator 
to  change  the  rectilinear  incision  last  described  into  a curvilinear 
incision.  The  marks  left  by  the  grinding  or  rasping  of  the  margin  are 
rough  and  irregular,  such  as  might  readily  be  produced  by  rubbing 
with  a coarse  sandstone  or  quartzite;  and  there  is  nothing  to  suggest 
the  use  of  specialized  or  metallic  instruments. 

The  location  of  the  operation  coincides  with  that  of  an  extensive 
compound  fracture,  most  of  the  traces  of  which  were  evidently  removed 
by  the  operator.  One  of  the  lines  of  fracture  extends  downward  from 
the  anterior  extremity  of  the  aperture  to  the  orbit,  and  may  be  traced 
in  the  wall  of  the  orbit  for  about  30  mm.,  and  in  the  interior  of  the 
skull  may  be  followed  thence  into  the  nasal  bones.  A branch  fracture 
defines  the  anterior  extremity  of  the  aperture  for  5 mm.,  and  thence 


54 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


extends  horizontally  for  16  mm.,  or  nearly  to  the  median  line,  as 
shown  in  plate  xxxix,  while  immediately  above  it  the  tables  are  sepa- 
rated and  a scale  of  the  inner  table  6 or  7 mm.  across  is  depressed,  as 
shown  in  plate  xl.  The  antero  inferior  margin  of  the  aperture  is 
defined  for  15  mm.  back  of  the  vertical  fissure  by  an  undercut  fracture 
in  which  the  outer  table  projects  1 to  3 mm.  It  seems  possible,  though 
by  no  means  probable,  that  some  of  this  fracturing  might  have  been 
produced  in  the  operation.  Below  the  posterior  portion  of  the  aperture 
a conspicuous  crack  in  the  outer  table  may  be  traced  from  the  point  at 
which  the  margin  of  the  aperture  coincides  with  the  coronal  suture 
horizontally  backward  for  about  50  mm.,  as  imperfectly  shown  in 
plate  xl.  There  are  indications  also  of  a fracture  coinciding  with  the 
coronal  suture  30  mm.  downward  from  the  lower  side  of  the  aperture. 
Finally,  an  irregular  crack  extends  from  the  posterior  margin  of  the 
aperture  backward  for  5 or  6 mm.,  as  faintly  shown  in  plate  xl.  The 
character  and  distribution  of  these  fissures  suggest  an  extensive 
depressed  fracture  on  the  right  frontal,  at  a point  nearly  opposite 
the  indentation  on  the  left,  with  radial  fissures  extending  in  several 
directions.  There  are  numerous  indications  that  such  a wound  was 
explored  rather  extensively,  either  before  the  operation  or  in  connec- 
tion with  it,  especially  forward  and  downward  toward  the  orbit.  The 
clearest  marks  are  three  or  four  horizontal  scratches  midway  between 
the  anterior  end  of  the  aperture  and  the  outer  angle  of  the  orbit 
(somewhat  indistinctly  shown  in  plates  xxxix  and  xl);  and  less 
distinct  marks  are  found  over  the  superciliary  ridge  and  the  adjacent 
surface  of  the  bone  nearly  to  the  median  line  (as  obscurely  shown 
in  plate  xxxix). 

On  considering  the  various  features  displayed  by  the  specimen,  it 
becomes  evident  that  the  fracture  antedated  the  operation,  since  (1)  most 
of  the  lines  could  not  be  produced  by  any  conceivable  impact  against  the 
remaining  portion  of  the  skull,  while  (2)  some  of  the  fractures  (notably 
that  extending  backward  from  the  coronal  suture)  show  indications  of 
subsequent  physiologic  process.  It  is  certain,  also,  that  the  operation  • 
was  completed  to  the  satisfaction  of  the  operator,  since  no  rough  edges 
of  bone  were  left  save  a few  projections  of  the  inner  table,  which  was 
necessarily  difficult  of  access.  Finally  it  may  be  considered  as  estab- 
lished that  the  individual  survived  the  operation,  since  in  this  case,  and 
this  only  (so  far  as  the  Muniz  collection  is  concerned),  a plate  of  shell 
was  found  fitted  to  the  aperture.1  Judging  from  the  specimen  the 
operation  was  not  long  survived,  since  there  is  no  definite  trace  of 
reparative  growth,  and  since  traces  of  periostitis,  apparently  con- 
nected with  the  wound  or  with  the  subsequent  operation,  may  be 
detected,  especially  about  the  coronal  suture  below  the  aperture  and 
along  the  principal  fissure  extending  backward  into  the  parietal. 

1 Unfortunately  this  plate,  together  with  all  the  rest  of  the  collection  excepting  the  nineteen  tre- 
phined crania,  has  been  destroyed. 


BUREAU  OF  AMERICAN  ETHNOLOGY  SIXTEENTH  ANNUAL  REPORT  PL.  XL 


RIGHT  LATERAL  ASPECT  OF  CRANIUM  19 


MUNIZ— MC  GEE  ] 


MANIPULATIONS  OF  THE  OPERATORS 


55 


METHOD  OF  OPERATING 

Tlie  twenty-four  or  more  operations  exhibited  by  the  nineteen  crania 
reveal  clearly  and  conclusively  the  methods  pursued  by  the  operators. 
On  reviewing  the  operations,  it  appears  that  the  methods  were  simple, 
comprising  three  types  of  manipulation,  which  were  combined  in  many 
instances,  probably  in  all  of  the  completed  operations.  These  types 
are  (1)  incising,  (2)  elevating,  and  (3)  rasping  (i.  e.,  grinding,  filing 
or  scraping  away  the  bone  by  a rough- surfaced  or  irregular-edged 
instrument). 

The  incising  was  of  two  fairly  distinct  but  intergrading  subtypes, 
(a)  rectilinear  and  ( b ) curvilinear.  All  of  the  incisions,  so  far  as 
clearly  revealed,  both  rectilinear  and  curvilinear,  are  essentially  similar 
in  form;  they  are  V-shape  in  section  and  canoe-shape  in  plan,  broadest 
and  deepest  toward  the  middle,  where  alone  they  penetrate  the  bone, 
shallowing  and  narrowing  toward  the  extremities,  which  frequently 
project  beyond  the  margin  of  the  aperture.  The  rectilinear  incisions 
are  frequently,  and  the  curvilinear  cuts  commonly,  more  or  less  oblique 
to  the  tangent  plane  passing  through  the  point  of  cutting. 

The  rectilinear  incisions  are  well  displayed  in  several  specimens, 
either  combined  in  such  manner  as  to  describe  quadrilaterals,  as  in 
crania  1,  2,  3,  and  4,  or  less  regularly  disposed,  perhaps,  about  the 
margins  of  depressed  fractures,  as  in  crania  5,  14,  15,  and  19,  or  else 
distributed  at  random  as  in  crania  1 (the  outlying  incision),  16,  and  17, 
in  addition  to  the  many  examples  of  minor  cutting  or  scratching 
described  as  exploratory. 

The  development  of  rectilinear  incision  into  curvilinear  cutting  is 
well  illustrated  by  several  examples.  In  cranium  4,  three  of  the  six 
incisions  became  curved  in  consequence  of  the  oblique  attitude  in 
which  the  instrument  was  held  by  the  operator  in  its  passage  across 
the  spherical  surface  of  the  skull,  and  a fourth  incision  was  strongly 
curved  toward  one  of  its  extremities,  evidently  because  of  deflection  of 
the  instrument  by  the  superciliary  ridge;  and  one  of  the  random  cuts 
in  cranium  16  is  curved  at  both  extremities,  by  reason  of  rugosities  of 
the  surface  of  the  bone,  in  such  manner  as  to  assume  a somewhat 
curvilinear  form.  In  other  cases  the  incisions  were  evidently  curved  by 
studied  effort,  as  most  clearly  shown  in  cranium  6.  In  this  case  it  is 
clear  that  the  operator  began  with  a rather  short  vertical  and  recti- 
linear incision,  which  was  in  one  direction  developed  iuto  a curve, 
partly  by  lateral  deflection  of  the  instrument  at  one  end  of  the  recip- 
rocal stroke,  partly  by  holding  it  more  obliquely  as  the  cutting  pro- 
ceeded. Of  like  significance  are  the  partly  rectilinear  partly  curvilinear 
incisious  displayed  in  crania  7 (the  later  operation),  IS,  and  19;  while 
in  still  other  cases,  in  which  the  marks  of  instrumentation  have  beeu 
obscured  by  subsequent  rasping  or  obliterated  by  reparative  growth, 
the  form  of  the  aperture  suggests  a similar  combination  of  rectilinear 


5(5 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  15 


incision  developed  into  curvilinear  cutting,  as  in  crania  9,  11,  12,  13, 
and  18  (the  two  earlier  operations).  In  only  one  case  (cranium  8)  does 
the  curvilinear  cutting-  closely  approach  circularity,  and  even  in  this 
case  one  side  is  a tangent  exceeding  half  the  diameter  of  the  aperture, 
while  there  are  indications  that  the  final  rasping  was  designed  to 
remove  projecting  termini  and  scratches  produced  in  the  gradual 
diversion  of  an  originally  rectilinear  cut. 

Accordingly  the  first  type  of  manipulation  may  be  traced  from  simple 
rectilinear  incisions,  either  random  or  arranged  quadrilaterally,  through 
various  combinations  of  straight  and  curved  cuts  up  to  approximate 
circularity;  in  which  form,  of  course,  the  extent  of  the  lesion  and  the 
vital  force  required  for  recovery  and  reparation  are  reduced  to  a mini- 
mum. It  is  not  known  that  this  sequence  has  either  geographic  or 
chronologic  significance ; the  lowest  types  (crania  1 and  2)  are  both  from 
Huarochiri,  as  is  also  the  highest  (cranium  8),  and  there  is  nothing  save 
the  differentiation  in  method  to  suggest  difference  in  period.  It  is  on 
the  whole  probable  that  the  differences  in  refinement  in  manipulation 
merely  represent  varying  degrees  of  skill  on  the  part  of  essentially 
contemporary  operators. 

The  elevation  of  the  button  outlined  and  partially  dissevered  by  the 
incisions  is  indicated  clearly  in  one  case,  and  with  strong  probability  in 
at  least  six  others,  and  is  suggested  in  several  additional  cases.  In 
cranium  4 one  of  the  margins  of  the  irregular  aperture  is  crushed, 
splintered,  and  undercut  in  such  manner  as  to  record  unmistakably  the 
application  of  the  elevator  lever-fashion  over  this  part  as  a fulcrum; 
while  the  broken  edges  of  the  inner  table  and  the  margins  of  the  aper 
ture  generally  were  evidently  produced  by  the  forcible  elevation  and 
breaking  outward  of  the  button.  In  cranium  15  the  splinters  and  frag- 
ments of  the  fractured  bone  were  evidently  removed,  either  entire  or  in 
pieces,  so  forcibly  as  to  leave  jagged  edges,  especially  of  the  inner  table, 
and  carry  one  side  of  the  aperture  beyond  the  incision  designed  to  define 
it.  In  cranium  7 (the  later  operation)  the  thick  button  was  apparently 
forced  outward  by  strong  pressure  exercised  by  means  of  an  elevator 
inserted  in  the  incision  and  used  as  a lever  fulcrumed  on  the  outer  wall 
of  bone,  whereby  one  of  the  margins  of  the  aperture  was  carried  beyond 
the  limiting  incision  in  the  inner  table;  the  thin  edge  of  the  inner 
part  of  the  bone  about  the  latest  aperture  in  cranium  18  tells  a similar 
story,  and  suggests  that  the  tables  were  separated  before  the  button 
was  finally  removed;  and  equally  decisive  are  the  jagged  edges  of  the 
inner  table  part  of  the  way  around  the  immense  aperture  in  cranium  19. 
In  crania  1,  2,  5,  12,  and  17  also  there  are  jagged  margins,  especially  of 
the  inner  table,  which  could  have  been  produced  only  by  the  forcible 
removal  of  the  button  through  outward  pressure  applied  by  means  of 
an  elevator.  As  with  incising,  so  also  with  elevating,  there  are  several 
cases  in  which  no  evidence  of  the  process  remains;  but  (excluding  the 
examples  of  rasping)  these  are  cases  in  which  the  marks  of  instrumen- 


MUNIZ — MC  GEE] 


ELEVATING  AND  KASPING 


57 


tatiou  have  been  obliterated  by  subsequent  smoothing  of  edges  or  physi- 
ologic action.  There  is  no  case  in  which  traces  of  incising  persist  that 
does  not  afford  suggestion  or  more  decisive  proof  of  the  employment  of 
an  elevatory  process. 

The  process  of  rasping  is  distinctly  exemplified  by  several  of  the 
specimens.  Perhaps  the  clearest  evidence  is  that  afforded  by  cranium 
16,  which  displays  a complete  operation  without  trace  of  incision  or 
elevation,  apparently  produced  wholly  by  rasping,  scraping,  or  grind- 
ing. It  is  true  that  the  outlyiug  marks  are  for  the  most  part  indistinct, 
but  this  may  be  ascribed  to  increasing  delicacy  of  manipulation  as  the 
process  was  brought  to  an  end — a delicacy  attested  by  the  paper-like 
thinness  of  the  remaining  margin  of  the  inner  table;  and  a sufficient 
number  of  striae  are  preserved  to  at  least  suggest  the  extension  of  the 
process  over  the  entire  area  of  this  particular  operation.  In  addition, 
unmistakable  marks  of  rasping  or  scraping  follow  the  ghastly  fissure 
for  at  least  50  mm.,  where  they  merge  into  exploratory  scratches.  In 
cranium  10  the  conformation  of  the  aperture  and  its  margins  and  the 
adjacent  portions  of  the  skull  suggest  that  the  entire  operation  was 
performed  by  rasping  or  scraping,  precisely  as  in  cranium  16,  without 
attendant  incision,  although  in  this  case  all  direct  traces  of  instrumen- 
tation have  been  obliterated  by  reparative  process.  In  cranium  12  (the 
later  operation)  the  process  of  rasping  or  scraping  was  carried  over  a 
considerable  area,  and  one  of  the  three  apertures  appears  to  have  been 
produced  wholly  by  this  process;  and  in  crania  17  (the  upper  opening) 
and  19  the  apertures  are  circumscribed  by  approximately  concentric 
striae,  showing  that  the  process  was  employed  for  working  down  rough 
edges.  So,  too,  in  crania  7 (the  later  operation)  and  18  (the  latest 
operation)  the  striae  are  so  disposed  as  clearly  to  indicate  that  rasping 
was  employed  to  smooth  the  bony  edges  and  obliterate  the  rough  pro- 
jecting kerfs  due  to  irregularity  in  incision,  and  the  same  relation  is 
indicated  with  almost  equal  clearness  by  the  striae  about  the  nearly 
circular  aperture  in  cranium  8. 

Several  of  the  specimens  are  without  traces  of  rasping  or  scraping. 
These  fall  into  two  groups,  in  one  of  which  the  operation  was  evidently 
incomplete,  while  in  the  second  the  more  delicate  (at  least)  of  the  marks 
of  instrumentation  have  been  obliterated  by  physiologic  process.  Tb 
the  first  group  belong  crania  1,  2,  3,  4,  5,  6,  14,  and  15,  all  of  which 
afford  independent  indications  that  the  subjects  died  under  the  knife, 
either  in  consequence  of  the  original  lesion  or  from  the  effects  of  the 
operation.  The  second  group  comprises  crania  7 (the  earlier  opera- 
tion), 13  (both  operations),  and  18  (the  two  earlier  operations),  with 
more  doubtfully  crania  9 and  11,  in  which  there  is  collateral  evidence 
of  long  survival  and  extensive  reparative  process.  In  every  case  in 
which  the  operation  was  presumptively  complete,  and  in  which  traces 
of  instrumentation  have  not  presumptively  been  obliterated  by  physio- 
logic action,  as  well  as  in  several  others,  rasping  is  exemplified. 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


58 


Summarily,  it  appears  that  the  three  processes  of  incising,  elevating, 
and  rasping  were  commonly  and  perhaps  invariably  employed  in  defi- 
nite sequence  in  producing  a complete  operation;  in  general,  the  treat- 
ment began  with  exploratory  scraping  or  cutting  and  proceeded  to 
definite  incision;  at  a stage  determined  by  the  conditions  the  operator 
had  recourse  to  elevation  and  thereby  forcibly  and  often  violently  dis- 
severed the  button ; as  the  operation  approached  completion  the  edges 
of  the  bone  were  reduced  by  rasping  or  scraping.  There  are  only  one 
or  two  cases  in  which  there  is  not  either  direct  or  strong  presumptive 
evidence  of  the  process  of  incising;  in  most  of  the  cases  also  there  is 
either  direct  or  strongly  presumptive  evidence  of  elevating,  and  in 
every  suitably  conditioned  case  there  is  conclusive  evidence  of  rasping. 

INSTRUMENTS 

More  than  half  of  the  specimens  indicate  with  considerable  clearness 
the  character  of  the  incising  instrument  and  somewhat  less  clearly  the 
nature  of  the  rasping  instrument,  while  there  is  little  indication  con- 
cerning the  instrument  used  as  an  elevator. 

The  incising  instrument  evidently  possessed  a single  rather  blunt 
point,  without  shoulders  or  other  device  to  limit  the  depth  of  cutting; 
the  bluntness  is  indicated  by  the  width  of  the  bottom  of  the  kerf,  which 
is  always  rounded  or  concave  for  a width  ranging  from  0.5  mm.  to  1.5 
mm.;  the  fact  that  the  point  was  single  is  indicated  by  the  frequency 
with  which  it  slipped  toward  the  termini  of  the  incisions  and  by  the 
character  of  the  scratches  thereby  produced,  while  the  absence  of 
shoulder  is  indicated  by  the  variability  in  depth  of  the  incisions  and  by 
the  freedom  of  the  margins  of  the  incisions  from  striation  or  other  marks 
of  friction  in  every  case  in  which  the  details  of  the  operation  are  clear. 
In  addition  to  bluntness  at  the  tip,  the  instrument  thickened  rapidly 
in  the  body,  as  attested  by  the  somewhat  flaring  V-sliape  of  the  inci- 
sions, which  are  frequently  as  wide,  and  never  less  than  half  as  wide,  as 
deep.  The  form  in  plau,  section,  and  longitudinal  profile  of  every  well- 
preserved  incision  indicates  that  the  single  point  was  operated  by  a 
reciprocal  motion,  so  as  to  form  a single-tooth  saw,  sufficient  downward 
pressure  being  exercised  to  cause  it  to  “bite”  the  bone,  and  thus  pro- 
duce a kerf  haviug  a width  determined  by  the  thickness  of  the  instru- 
ment, and  a length  and  longitudinal  profile  determined  by  the  length  of 
stroke  and  the  center  of  partial  revolution  of  the  instrument  in  the 
hand  of  the  holder;  for  in  most  cases  iu  which  the  kerf  is  well  pre- 
served the  longitudinal  profile  is  more  or  less  concave,  indicating  that 
the  tip  of  the  instrument  moved  through  a longer  radius  than  its  head. 
Also  the  well-preserved  incisions  indicate  that  the  instrument  was  not 
only  blunt-tipped  but  rough-sided,  for  the  sides  of  the  kerfs  are  striated 
longitudinally,  though  somewhat  irregularly. 

There  is  nothing  to  suggest  in  any  case  that  the  point  of  the  instru- 
ment was  round  or  square,  and  decisive  indications  in  many  cases  that 


MUNIZ — MC  GEE] 


INSTRUMENTS  WERE  OF  STONE 


59 


the  rather  blunt  tip  expanded  longitudinally  in  the  form  of  a blade 
considerably  broader  than  thick.  The  rectilinear  incisions  give  little 
indication  of  the  relative  width  and  thickness  of  the  tools,  but  the 
curvilinear  kerfs  suggest  that  the  longitudinal  width  must  have  been 
two  or  three  or  more  times  the  transverse  dimension — i.  e.,  that  the  tool 
must  have  been  a blade  measuring,  at  a distance  of  say  8 mm.  from  the 
tip,  about  3 or  4 mm.  from  side  to  side,  and  somewhere  between  5 and 
10  mm.  from  edge  to  edge. 

It  is,  of  course,  impossible  to  estimate,  with  auy  approach  to  accuracy, 
the  length  of  the  blade,  which  might  or  might  not  have  been  hafted, 
but  it  is  practicable  to  estimate  roughly  the  total  length  of  the  instru- 
ment, including  the  haft,  if  hafted,  from  the  curvature  in  bottom  pro- 
file of  the  incisions,  assuming  the  tool  to  have  been  held  in  convenient 
fashion  in  one  hand ; and  such  an  estimate,  based  on  the  well-preserved 
incisions  in  crania  1,  2, 14,  15, 16,  and  17,  ranges  from  about  50  or  75  to 
some  150  or  200  mm.;  i.  e.,  it  seems  probable  that  the  instrument  was 
long  enough  to  be  handled  conveniently  in  one  hand,  with  the  occasional 
assistance  of  the  other. 

Putting  the  various  dimensions  together,  they  are  found  to  define  a 
blade  corresponding  with  an  ordinary  stone  knife  or  spearhead,  or  with 
an  arrowpoint  attached  to  a short  haft,  while  the  dimensions  are  incon- 
sistent with  those  possessed  by  any  known  cutting  instrument  of  metal. 
Considering  next  the  longitudinal  striae  in  the  sides  of  the  kerfs,  it 
appears  that  they  would  naturally  and  necessarily  be  produced  by  the 
reciprocal  operation  of  a knife  or  spearhead  chipped  from  stone  of 
coarse  texture  or  of  such  structure  as  to  give  a splintery  fracture,  and 
that  these  features  would  not  be  produced  by  any  known  single-point 
tool  of  metal,  polished  stone,  tooth,  or  shell.  Accordingly,  the  detailed 
features  displayed  by  the  collection  afford  practically  conclusive  evi- 
dence that  the  incising  instrument  was  a stone  blade  of  common  form 
and  character.  There  is  absolutely  no  suggestion  in  any  of  the  speci- 
mens that  the  kerfs  were  produced  by  any  other  kind  of  tool,  either  of 
other  material  than  stone  or  of  other  form  than  a blunt  single- tip  blade. 

Several  of  the  crania  indicate  that  the  rasping  was  effected  by  an 
irregularly  rough  surface,  since  the  strife  are  unequal  iu  depth  and 
variable  in  contour  and  length.  Iu  only  a single  instance  (cranium  8) 
are  the  strife  sufficiently  uniform  even  to  suggest  the  use  of  a regularly 
formed  rasp  or  file  of  metal  or  other  tough  material,  and  even  in  this  case 
careful  examination  shows  that  the  uniformity  is  almost  certainly  due 
to  exceptional  shortness  of  stroke  in  beveling  the  narrow  marginal  zone 
(1  to  9 mm.  in  width)  of  the  outer  table  of  the  skull.  In  most  cases  the 
strife  are  jirecisely  such  as  those  traversing  longitudinally  the  sides  of 
the  cuts,  and  this  similarity  suggests  that  they  were  effected  simply  by 
rubbing  with  the  side  of  a blade  chipped  from  stone  of  coarse  texture 
or  splintery  fracture. 


60 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


In  some  cases  the  size  of  the  instrument  used  for  rasping  is  roughly 
indicated.  The  grinding  out  of  the  kerf  terminals  in  crania  7 (the  later 
operation)  and  18  (the  latest  operation)  produced  sui’faces  curved  in 
two  dimensions,  of  such  degree  of  curvature  as  to  indicate  that  the 
instrument  must  have  been  about  the  size  of  the  blade  inferred  from 
the  incisions;  moreover,  in  cranium  lGthe  strife  traversing  the  fracture 
terminate  anteriorly  iu  a series  of  scratches  precisely  such  as  accom- 
pany the  kerf  terminals,  suggesting  that  in  this  instance,  at  least,  the 
strife  were  produced  by  the  distal  portion  of  a blunt-point  instrument 
corresponding  generally  to  the  incising  tool. 

Accordingly,  there  is  a fairly  conclusive  body  of  evidence  that  the 
rasping  was  effected  by  means  of  common  stone  implements,  either 
identical  with  or  closely  similar  to  those  used  in  cutting,  and  there  are 
no  marks  which  might  not  be  produced  by  such  an  instrument,  nor  is 
there  the  least  indication  that  instruments  of  metal,  tooth,  or  shell 
were  employed,  though  it  is  possible  that  some  of  the  work  (e.  g.,  in 
cranium  10,  in  which  the  traces  of  instrumentation  are  practically  oblit- 
erated) might  have  been  performed  with  other  materials  than  stone,  the 
scraping  of  the  South  Sea  islanders  being  suggested. 

Iu  the  single  case  in  which  the  bony  fulcrum  of  the  elevator  is  dis- 
tinctively preserved  ^cranium  4),  the  marks  iudicate  merely  that  the 
instrument  was  rough  or  irregular,  rather  than  smoothly  rounded,  sug- 
gesting that  the  elevator  was  nothing  more  than  the  stone  blade  used 
in  making  the  incision.  In  several  cases,  however,  there  are  indications 
that  considerable  force  was  exerted  in  raising  the  button,  perhaps 
requiring  a tougher  material  than  stone,  which  suggests  that  special 
instruments  of  tooth,  antler,  or  hard  wood  might  have  been  employed 
for  this  purpose. 

It  may  be  noted  in  passing  that  the  Squier  cranium  corresponds  in 
indications  of  instrumentation  with  crania  1 and  3 of  the  Muniz  collec- 
tion, while  several  of  the  Cuzco  crania  indicate  the  employment  of 
dissimilar  methods  and  distinct  instruments;  but  in  the  absence  of 
decisive  facts,  such  as  can  be  obtained  only  by  critical  examination 
of  the  specimens  themselves,  these  examples  of  Peruvian  trephining 
may  be  passed  over  without  detailed  consideration. 

Summarily  it  appears  that  the  instruments  used  in  performing  the 
operations  exemplified  in  the  Muniz  collection  were  chiefly  or  exclu- 
sively stone  implements  of  the  character  found  among  nearly  all  primi- 
tive peoples,  including  the  ancient  Peruvians.  There  is  nothing  to 
indicate  that  the  instruments  were  in  any  way  specialized;  there  is 
absolutely  no  indication  of  the  employment  of  trephines,  saws,  or  other 
multiple-point  instruments,  and  only  negative  suggestions  concerning 
the  use  of  metal. 


MUNIZ— JIC  GEE] 


RUDENESS  OF  TECHNIQUE 


61 


PROCEDURE  OF  THE  OPERATORS 

Some  idea  as  to  the  technique  of  Peruvian  trephining  may  be  gained 
from  a study  of  the  procedure  of  the  operators,  as  indicated  by  the 
character  and  sequence  of  steps  in  the  better  revealed  operations. 
There  are  many  indications  that  the  operators  were  (1)  inexpert  in 
manipulation,  (2)  ignorant  of  physiology,  (3)  skilless  in  diagnosis  and 
treatment,  and  (4)  regardless  of  the  gravity  of  the  operations  performed. 

As  already  noted,  there  was  a sequence  in  refinement  of  the  bone  cut- 
ting, running  from  the  extravagant  quadrangular  button  with  eight 
projecting  kerfs  exemplified  by  cranium  1,  and  the  still  more  barbarous 
slashing  shown  in  cranium  5,  to  the  relatively  refined  circular  incision 
of  cranium  8.  Yet  there  is  nothing  to  indicate  that  the  sequence  means 
anything  more  than  a simple  transition  from  the  more  clumsy  to  the 
less.  There  is  scarcely  a specimen,  not  modified  by  reparative  growth, 
that  does  not  display  more  or  less  extended  kerf  terminals  and  exten- 
sive scratches  produced  by  the  slipping  of  the  tool;  and  the  apertures 
display  an  irregularity  of  form  attesting  unfamiliarity  either  with  geo- 
metric proportion  in  general  or  with  the  production  of  geometric  figures 
by  means  of  the  facilities  and  under  the  conditions  represented  by  the 
work.  Most  of  the  operations  were  evidently  performed  in  random 
fashion  without  definite  plan,  by  rule  of  thumb  or  by  no  rule  at  all. 
There  was  apparently  no  uniformity  in  the  orientation  of  the  quadran- 
gular operations  save  that  of  convenience  in  operating,  and  in  several 
cases  (e.  g.,  in  the  later  operation  in  cranium  7,  in  cranium  8,  and  in  the 
latest  operation  in  cranium  18)  the  outline  of  the  cutting  was  mani- 
festly determined  by  the  attitude  in  which  the  subject  was  placed.  In 
some  of  the  more  refined  operations  the  incising  blade  was  apparently 
held  in  such  manner  as  to  produce  a tapering  button  and  beveled  mar- 
gin, yet  most  of  the  rectilinear  and  some  of  the  curvilinear  kei  fs  indicate 
that  the  tool  was  variously  inclined,  either  through  pure  clumsiness  and 
inattention,  as  in  the  outlying  incision  in  cranium  1,  in  which  (apparently 
by  reason  in  part  of  interference  with  the  integument)  the  tool  was 
inclined  at  such  an  angle  to  the  tangent  as  to  require  the  cutting  of  bone 
to  nearly  twice  the  normal  thickness  of  the  skull,  or  by  effort  to  keep 
the  hand  (and  tool)  out  of  the  way  of  vision,  as  in  cranium  8.  So,  too, 
when  the  bony  surface,  was  irregular  or  protuberant  the  tool  was  per- 
mitted to  diverge,  regardless  of  the  original  direction,  as  in  crania  4 
and  16.  In  short,  there  is  nothing  to  indicate  definite  plan  or  deft 
execution  in  any  of  the  operations. 

The  extravagant  incision  and  violent  elevation  characterizing  many 
of  the  operations  necessarily  rendered  the  artificial  lesions  much  more 
extensive  and  dangerous  than  necessary,  and  the  frequency  with  which 
this  needless  danger  was  incurred  indicates  that  the  operators  had 
little  if  any  notion  of  the  physiologic  processes  involved  in  resistance, 
recovery,  and  reparation.  In  several  cases,  too,  the  cutting  was  care- 
lessly carried  entirely  through  the  bony  tables  so  extensively  as  to 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


G2 

indicate  that  the  tool  penetrated  the  intracranial  tissues  in  such  man- 
ner that  the  operation  probably  became  the  immediate  cause  of  the 
death  of  the  victim,  as  in  crania  1,  4,  5,  and  17,  and  perhaps  2,  3,  6,  12 
(the  later  operation),  and  15;  this  highly  indefensible  procedure  appar- 
ently growing  out  of  ignorance  concerning  the  delicacy  of  brain  and 
meninges.  Again,  the  apertures  seem  to  be  located  altogether  at  ran- 
dom with  respect  to  the  structures  affected;  no  fewer  than  nine  of  the 
twenty-four  operations  involve  sutures,  and  at  least  two  (crania  13  and 
18)  were,  apparently  needlessly,  so  located  as  to  traverse  the  sagittal 
suture  about  its  union  with  the  coronal,  thereby  endangering  especially 
delicate  and  conspicuous  structures.  Several  of  the  operations  were, 
indeed,  evidently  located  by  wounds,  and  these  cases  might  be  con- 
sidered so  desperate  as  to  override  ordinary  prudence;  yet  a sufficient 
number  are  so  manifestly  ill  placed  as  to  indicate  that  the  operator 
knew  not  whereof  he  wrought. 

While  the  inference  seems  unavoidable  that  some  of  the  operations 
were  intentionally  located  by  traumatic  lesions — indeed,  the  evidence 
of  cranium  14  alone  would  appear  conclusive  on  this  point,  even  if  it 
were  not  corroborated  by  that  of  15,  16,  17,  and  19 — yet  there  are  a 
number  of  examples  of  aberrant  location  and  erratic  exploration.  In 
cranium  1 no  trace  of  antecedent  lesion  can  be  found  about  the  locus 
of  operation,  though  there  was  an  evidently  fresh  wound,  of  a severity 
indicated  by  fracturing  of  the  outer  table,  in  a remote  part  of  the  skull; 
yet  there  is  no  indication  of  treatment  about  the  wound,  while  explora- 
tory marks  are  found  30,  40,  and  even  50  mm.  away  from  the  center 
of  the  operation  in  the  four  cardinal  directions,  and  the  great  out- 
lying incision  would  seem  to  have  been  exploratory  or  experimental. 
So  also  the  score  of  widely  distributed  incisions,  with  exploratory 
scratches  extending  25  mm.  farther,  displayed  by  cranium  5,  tell  of 
thoughtless  hacking,  with  no  indication  of  diagnosis  or  intelligent 
adaptation  of  means  to  ends.  The  fact  that  curative  treatment  was 
essayed  at  all  in  connection  with  the  fearful  wound  displayed  by 
cranium  10  would  airpear  to  indicate  utter  incompetence  in  diagnosis; 
and  the  fact  that  the  chief  treatment  was  located  far  from  the  center 
of  the  lesion,  and  that  some  of  the  more  ambitious  slashes  were 
entirely  beyond  the  region  affected  by  the  extensive  fracture,  strongly 
indicates  absence  of  diagnosis  in  the  ordinary  sense,  and  demonstrates 
that  the  treatment  was  altogether  inapplicable.  In  cranium  17,  too, 
the  operator  went  far  afield  in  his  earlier  efforts,  and  evidently  com- 
pleted an  operation  that  had  very  little  to  do  with  the  essential  features 
of  a wound  which  must  have  displayed  conspicuous  symptoms,  and  it 
is  evident  that  he  only  approached  the  real  locus  of  the  lesion  subse- 
quently, and  then  in  an  indefinite  and  blundering  fashion  which  appar- 
ently resulted  in  the  death  of  the  long-suffering  subject.  These  cases 
of  obvious  blundering  might  be  doubled  or  tripled  in  the  collection; 
they  are  only  typical.  Thus  there  are  several  examples  of  glaringly 


MUNIZ — JIC  GEE] 


RECKLESSNESS  OF  THE  OPERATORS 


63 


defective  diagnosis  and  ill-directed  treatment,  while,  witli  the  possible 
exception  of  crania  14  and  15  (in  which  the  indications  may  easily  be 
illusive),  no  examples  are  found  to  prove  or  even  to  suggest  diagnostic 
skill — there  is  much  evidence  against  and  no  evidence  in  favor  of  the 
competence  of  the  primitive  practitioner. 

A striking  feature  of  the  collection  is  the  magnitude  and  boldness  of 
the  operations  displayed  by  the  crania.  In  one  instance  (cranium  2) 
the  operator  evidently  sought  to  minimize  the  area  affected  by  his  treat- 
ment; in  another  instance  (cranium  8)  the  operation  suggests  studied 
economy  of  vital  force;  in  two  cases  (crania  14  and  15)  the  treatment 
was  coextensive  with  the  traumatism;  while  in  three  cases  (crania  16, 
17,  and  19)  the  treatment  was  more  restricted  than  the  antecedent 
lesion.  In  nearly  all  the  other  cases  the  treatment  seems  to  have  been 
nnnecessarily  extravagant,  while  in  several  instances  (already  noted) 
the  cutting  was  so  reckless  as  almost  necessarily  to  invade  the  cerebral 
tissues  and  occasion  the  death  of  the  subjects.  Even  in  the  three  cases 
in  which  the  antecedent  lesion  was  more  extensive  than  the  treatment, 
the  recklessness  of  procedure  is  indicated  by  aberrant  location,  as  well 
as  by  the  fact  that  the  operation  was  undertaken  in  connection  with 
almost  necessarily  fatal  wounds,  as  must  have  been  clearly  indicated 
by  unmistakable  conditions  and  symptoms.  So,  too,  complete  disre- 
gard of  suffering  on  the  part  of  the  patients  is  attested  by  the  rude 
and  wide-reaching  scratches  and  the  violent  outwrenching  of  the  but- 
tons, while  the  extensive  wounding  of  the  periosteum  was  barbarous, 
largely  needless,  and  wholly  irrational.  The  only  definite  suggestion 
of  post-mortem  operation  found  in  the  collection  arises  in  the  reckless 
and  inhuman  slashing  of  integument,  bone,  and  brain  by  evidently 
needless  operations. 

In  short,  Peruvian  trephining,  as  exemplified  in  the  Muniz  collection, 
can  only  be  regarded  as  crude  in  plan  and  bungling  in  procedure;  and 
study  of  the  procedure  only  occasions  surprise  that  the  results  were 
not  worse,  and  awakens  admiration  for  the  powerful  vitality  which 
enabled  so  large  a proportion  of  the  victims  to  survive. 

THE  MOTIVE  FOR  OPERATING 
GENERAL  INDICATIONS  OF  MOTIVE 

The  characteristics  of  the  crania  throw  some  light  on  the  question 
as  to  the  motives  actuating  the  primitive  practitioners  of  Peru.  Six- 
teen and  probably  17  or  18  of  the  19  specimens  are  almost  certainly 
mascujine,  and  represent  early  and  vigorous  maturity;  all  of  the  well- 
preserved  examples  are  remarkable  for  the  thickness  and  strength  of 
the  bone  and  the  rugosity  of  the  ligament  attachments,  while  the  ill- 
preserved  specimens  apparently  differ  only  by  reason  of  the  weathering 
and  erosion  to  which  they  have  been  subjected.  The  first  specimen  of 
doubtful  gender  is  the  fragmentary  cranium  6,  which  is  questionable 


64 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


only  by  reason  of  the  fact  that  the  single  parietal  bone  does  not  admit 
of  satisfactory  comparison  with  the  entire  specimens ; the  second  is  the 
small  and  delicately  molded  cranium  12,  which  may  be  feminine;  the 
third  is  the  small  specimen  of  somewhat  abnormal  appearance  (number 
19)  with  mature  sutures  and  immature  dentition,  which  may  be  feminine 
also,  though  it  seems  quite  as  probable  that  it  represents  an  ill-developed 
male.  Collectively  the  crania  appear  to  represent  vigorous  and  healthy 
yonug  men,  presumptively  soldiery;  there  is  every  indication  of  fine 
physical  development,  not  only  in  strength  of  tissue,  but  in  soundness  of 
constitution  as  indicated  by  the  frequent  survival  of  desperate  wounds 
and  even  more  desperate  treatment;  yet  there  is  nothing  in  the  crania 
themselves  or  in  the  evidence  of  the  instruments  and  operations  to 
indicate  noteworthy  intellectual  development. 

The  individual  and  collective  characteristics  indicated  by  osseous 
and  muscular  development  are  no  less  clearly  shown  in  the  minor  trau- 
matic lesions  displayed  by  most  of  the  crania.  Cranium  1 displays  a 
late  ante-mortem  contusion  with  slight  fracture  of  the  frontal  bone  and, 
in  addition,  two  long  healed  grooves  over  the  left  temple;  cranium  2 
reveals  a similar  groove  over  the  right  temple,  an  extensive  indentation 
of  the  frontal  bone,  and  two  suggestive  gashes  in  the  back  of  the  head 
(perhaps  pathologic) ; cranium  4 exhibits  an  indentation  some  25  mm. 
in  diameter,  evidently  traumatic,  near  the  center  of  the  right  half  of 
the  frontal  bone;  cranium  5 displays  traces  (partially  obliterated  by 
the  subsequent  hacking  of  the  operation)  of  the  customary  vertical 
groove  over  the  left  temple;  cranium  7 reveals  two  such  grooves  on  the 
left,  and  two  others  of  exceptional  length  on  the  right;  cranium  10  has 
two  long  parallel  grooves,  somewhat  fresher  in  aspect  than  usual,  over 
the  right  temple,  and  two  others,  iorming  a narrow  V over  the  left  tem- 
ple, with  a shorter  one  placed  exceptionally  low  on  either  side,  or  in  all 
six  cuts  symmetrically  grouped;  cranium  11  is  distorted  and  greatly 
fiattened  in  the  antero  posterior  dimension,  and  displays  the  character- 
istic groove  on  the  right;  cranium  12  exhibits  an  extensive  contusion  at 
the  summit  of  the  frontal  bone,  two  less  extensive  indentations  near  the 
center  of  the  left  half  of  the  same  bone,  an  abnormal  scale  at  the  anterior 
angle  of  the  right  parietal,  and  a long  healed  groove  on  the  left  side  of 
the  frontal;  cranium  15  displays  a completely  healed  contusion  in  the 
center  of  the  frontal,  a short  gash  above  the  right  orbit,  and  one  of  the 
usual  grooves  above  either  temple,  with  a shorter  parallel  groove  on 
the  left;  there  is  in  addition  a partially  healed  fracture  and  indentation 
of  the  outer  table  near  the  left  upper  margin  of  the  frontal ; cranium 
16  displays  an  immense  scar,  perhaps  of  pathologic  rather  than  trau- 
matic origin,  a little  to  the  right  of  the  center  in  the  upper  part  of  the 
frontal,  and  there  are  the  usual  ante  mortem  grooves  above  the  tem- 
ples, that  on  the  left  being  particularly  long  and  deep;  cranium  17 
reveals  the  usual  groove  on  the  right,  with  an  inconspicuous  corre- 
sponding mark  on  the  left;  cranium  18  is  indented  by  a deep  groove  of 
the  usual  character  over  the  right  temple,  and  displays  a considerable 


MUNIZ — MC  GEE] 


SYSTEMATIC  MARKING  OF  CRANIA 


65 


though  not  very  deep  scar  midway  between  the  left  orbit  and  the 
crown,  and  a deeper  scar  near  the  center  of  the  right  parietal;  while 
cranium  19  shows  au  inconspicuous  mark  of  the  usual  character  over 
the  left  temple,  and  in  addition  a considerable  contusion  by  which  the 
outer  table  is  somewhat  crushed  and  both  tables  depressed.  These 
unmistakable  records  of  traumatic  history  are  additional  to  the  opera- 
tions, single  and  multiple,  and  to  the  more  or  less -extensive  wounds- 
with  which  several  of  them  are  connected.  There  are  accordingly  four 
classes  of  traumatic  injuries  represented,  viz,  (1)  those  produced  by  the 
trephiuiug,  (2)  the  antecedent  fractures  displayed  by  five  of  the  crania, 
(3)  the  curious  grooves  over  the  temples  exhibited  by  most  of  the  spec- 
imens, and  (1)  the  miscellaneous  indentations  and  bone  scars  displayed 
by  fully  half  the  crania.  Excluding  the  first  three  classes,  the  19  sped 
mens  display  no  fewer  than  11  traumatic  lesions  resulting  from  injuries 
to  the  head,  which  were  more  or  less  serious,  yet  always  of  such  severity 
as  to  leave  clear  traces  in  the  bony  structure;  and  nearly  all  of  these 
were  anterior.  The  five  wounds  of  the  second  class  were  of  such  sever- 
ity as  almost  necessarily  to  be  mortal.  This  remarkable  record  of  acci- 
dent indicates  that  the  individuals  lived  eventful  albeit  short  lives, 
anti  were  inured  to  blood  and  pain  and  accustomed  to  facing  danger. 
The  peculiar  scoring  above  the  temples  (of  which  23  examples  are  dis- 
played by  the  17  frontal  bones)  is  much  too  regular  to  be  ascribed  to 
fortuitous  wounding;  without  examination  of  a larger  number  of  crania 
and  careful  consideration  of  their  associations,  these  marks  may  not 
safely  be  interpreted  ; yet  it  may  be  suggested  (the  suggestion  arising- 
in  analogies  with  other  American  aborigines)  that  they  are  records  of 
ceremonial  observances  in  which  wounds  were  inflicted  on  young  men 
chosen  for  initiation  into  militant  or  other  orders.  The  scars  indicate 
lesions  no  more  serious  and  probably  less  painful  than  those  of  the 
Mandan  and  Hidatsa  tribes  of  Xortli  America,  while  some  of  the  Pueblo 
Indians,  who  are  still  more  closely  connected  in  culture  with  the  South 
American  peoples,  have  initiatory  ceremonies  involving  symbolic  wound- 
ing of  the  head,  which  can  only  be  regarded  as  the  vestige  of  an  archaic 
custom  of  actual  wounding  in  the  initiation.  So,  too,  the  “scarred 
skulls  from  Florida,”  recently  brought  to  light  by  Cushing,  are  marked 
by  regular  ridges  of  papuloid  bony  growth,  which  seem  to  have  resulted 
from  the  cicatrization  of  the  scalp;  the  inference  being  that  the  marks 
were  made  in  producing  a penpanent  symbolic  crest  of  hair,  supple- 
mented by  feathers,  etc.,  to  distinguish  the  warriors.1 

Some  indications  of  motive  may  be  found  in  the  antiquity  of  the 
collection,  as  evidenced  by  the  methods  of  operating.  In  every  case  in 
which  the  marks  of  instrumentation  are  preserved  they  point  clearly 
and  unmistakably  to  the  use  of  primitive  tools,  mainly  or  wholly  of 
stone;  there  is  no  suggestion  of  the  slightest  value  that  metal  was  used 
in  any  part  of  the  treatment;  and  while  there  is  a certain  similarity 


16  ETH- 


American  Anthropologist,  volume  x,  1897,  pp.  17-18. 

-5 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


66 

running  through  all  trephining  operations,  there  is  not  the  slightest  in- 
dication that  these  primitive  operations  were  influenced  by  the  refined 
methods  of  civilization,  and  strong  indications  that  some  of  them— 
notably  the  operations  by  rectangular  cutting — were  autochthonous. 
Accordingly  the  inherent  evidence  of  the  collection  appears  to  prove 
that  all  of  these  cases  of  trephining  antedated  the  advent  of  white  men, 
and  were  thus  essentially  prehistoric.1 

Another  indication  of  motive  may  be  derived  from  the  period  of  the 
operation  with  respect  to  the  liie  of  the  individual  treated.  Out  of  the 
fid  cases  represented  by  distinct  operations,  8 — recorded  by  crania  7 
(two  operations),  10, 12  (the  earliest  operation),  13  (two  operations),  and 
18  (the  two  earlier  operations) — survived  long  enough  to  permit  more 
or  less  extensive  reparative  changes  and  considerable  bony  growth, 
while  G other  cases — recorded  in  crania  8,  9,  11,  12,  18  (the  third  opera- 
tion), and  19 — apparently  survived  for  days  or  months,  and  in  some 
cases  perhaps  for  years.  Excluding  the  case  exemplified  by  cranium  19 
(in  which  the  antecedent  lesion  was  almost  necessarily  fatal)  this  gives 
a ratio  of  13  survivals  out  of  24  operations,  or  a percentage  quite  as 
high  as  that  of  modern  practice.  In  one  case  (that  exemplified  in  cra- 
nium 16)  it  is  clear  that  the  patient  died  under  the  operation,  and  that 
the  treatment  was  abandoned  without  closing  the  integument;  in  at 
least  2 cases  (those  of  crania  1 and  5)  there  is  xiractically  conclusive 
evidence  in  the  condition  of  the  bone  that  the  victim  died  in  or  very 
soon  after  the  operation;  while  in  3 other  cases  (recorded  in  crania  14, 
15,  and  17)  the  relation  between  the  cutting  and  evidently  antecedent 
wounds  indicates  that  the  patients  died  in  the  hands  of  the  operators. 
Accordingly,  in  0 (7  if  cranium  19  be  reckoned)  out  of  23  cases,  either 
the  operations  or  the  immediately  antecedent  lesions  were  undoubtedly 
fatal.  In  one  case  (represented  by  cranium  2)  death  seems  to  have 
supervened  on  an  operation  connected  with  the  diseased  condition  of 
the  bone;  and  there  remain  3 cases  (those  of  crania  3,  4,  and  6)  in  which 
the  state  of  preservation  is  hardly  such  as  to  indicate  the  relation  of 
the  operations  to  the  life  of  the  individual  with  certitude,  though  in 
two  of  these  there  is  forcible  suggestion  of  death  under  the  knife.  On 
the  whole,  it  is  certain  that  over  half  of  the  operations  were  long  ante- 
mortem, and  that  most  of  the  remainder  were  ante-mortem  at  least  in 
their  inception,  and  there  is  not  the  slightest  indication,  except  in  the 
otherwise  explicable  rudeness  of  the, treatment,  that  any  of  the  opera- 
tions were  post-mortem. 

Still  another  indication  concerning  motive  appears  in  the  form  and 
character  of  the  buttons  or  bony  fragments  removed  by  the  operators. 

It  may  be  noted  that  the  above  inference  from  the  trephined  crania  is  in  accord  with  A'oluminous 
and  indubitable  evidence  obtained  by  Dr  Muniz  that  all  of  the  arts  of  the  people  represented  by  the 
crania  were  archaic,  and  of  prehistoric  type  exclusively — indeed,  according  to  Dr  Muniz,  the  associations 
clearly  indicate  not  only  a pre-Spanish  but  a pre-Incan  age  for  the  ancient  trepliiners.  The  only 
notable  suggestion  of  less  antiquity  is  that  of  the  designation  given  by  Squier  to  the  skull  obtained  by 
him  from  Senora  Zentino,  and  said  to  have  been  taken  some  time  before  from  an  “ Inca  cemetery  in 
the  valley  of  Yucay”  (“  Peru— Incidents  of  Travel  and  Exploration  in  the  Land  of  the  Incas,”  1877, 
page  456) ; and  it  is  clear  that  in  this  case  the  evidence  of  Incan  'age  is  far  from  complete. 


MUNIZ— MCGEE]  INDEPENDENCE  OF  WOUNDS  AND  OPERATIONS 


67 


Cranium  A displays  cutting  in  sucli  manner  as  to  describe  four  irregu- 
larly rectangular  bits  of  bone,  while  the  work  on  cranium  5 yielded  a 
still  larger  number  of  still  more  irregular  fragments.  The  operation 
exemplified  by  cranium  S may,  indeed,  have  yielded  a circular  button, 
but  considerable  additional  bone  was  removed  in  minute  shreds  by 
subsequent  rasping.  If  the  operation  in  cranium  10  was  performed 
wholly  by  scraping,  as  appearances  indicate,  then  all  of  the  dislodged 
bone  came  away  in  shreds  or  filings;  in  the  later  operation  or  opera- 
tions on  cranium  12  most  of  the  bony  matter  seems  to  have  been  removed 
by  scraping;  in  cranium  14  bony  splinters  only  were  removed,  and  in 
cranium  15  such  splinters  in  connection  with  a probably  broken  bony 
tongue  of  irregular  form.  So,  too,  in  all  the  other  cases  there  are  unmis- 
takable indications  that  the  purpose  of  the  operator  was  to  produce  an 
aperture,  and  not  to  obtain  bone  fragments  of  any  particular  form  or 
size;  and  there  is  not  the  slightest  indication  in  any  of  the  specimens 
that  the  cutting  was  designed  to  yield  rondelles.1 

SPECIAL  INDICATIONS  OF  MOTIVE 

Strong  yet  somewhat  illusive  light  is  thrown  on  the  motives  actuat- 
ing the  prehistoric  practitioners  of  Peru  by  the  relations  between  tre- 
phining and  traumatic  lesions.  In  6 cases  (exemplified  by  crania  6, 
14-17,  and  10)  the  operations  were  evidently  located  by  grave  wounds. 
The  13  remaining  crania  display  IS  operations  having  no  traceable  con- 
nection with  lesions,  while,  as  already  enumerated,  no  fewer  than  14 
scars  of  more  or  less  serious  wounds  (some  of  considerable  gravity)  are 
displayed,  none  of  which  were  treated  by  trephining.  The  23  examples 
of  manifestly  intentional  wounding  of  such  severity  as  to  leave  bone 
scars  over. the  temples  may  be  neglected.  Accordingly  it  appears  that, 
while  there  are  a few  cases  of  indubitable  connection  between  operation 
and  antecedent  lesion,  this  relation  is  subordinate — in  most  cases  the 
cranial  lesions  did  not  lead  to  trephining,  while  in  the  great  majority 
of  cases  the  trephining  was  apparently  not  connected  with  traumatic 
lesion.  In  one  case  (cranium  2)  there  is  a strong  suggestion  that  the 
operation  was  connected  with  pathologic  lesion;  yet  this  case  does  not 
materially  affect  the  relations  between  lesion  and  trephining.  The  rela- 
tions may  perhaps  best  be  summarized  by  tlie  statements  (1)  that  most 
of  the  operations  were  independent  of  cranial  wounds  so  far  as  can  be 
ascertained;  (2)  that  most  of  the  cranial  lesions  were  not  followed  by 
trephining;  and  (3)  that  only  wounds  of  great  severity  were  followed 
by  cranial  treatment. 

On  considering  specially  the  six  crania  (6,  14-17,  and  19)  displaying 
operations  located  by  immediately  antecedent  wounds,  they  appear  to 

1 This  inference  from  the  crania  is  in  accord  with  the  general  results  of  Peruvian  collecting  by  Dr 
Muniz  and  others.  Among  the  many  thousand  specimens  representing  the  apparel,  ornaments,  and 
other  personal  appurtenances  found  by  Dr  Muniz  in  connection  with  more  than  a thousand  skeletons, 
and  despite  constant  search,  not  a single  rondelle  or  other  object  made  from  human  cranial  bone  was 
found  ; and  no  record  of  the  discovery  of  such  objects  by  any  of  the  numerous  students  of  Peruvian 
archeology  is  known. 


68 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


fall  into  three  categories.  In  the  first  category,  represented  by  crania 
6,  14,  and  15,  the  operations  were  located  by  depressed  fractures  of  con- 
siderable gravity,  and  the  procedure,  albeit  clumsy,  was  of  such  char- 
acter as  to  tend  to  afford  relief — i.  e.,  the  wounds  were  such  as  modern 
practitioners  would  treat  by  cranial  cutting,  including  the  removal  of 
bony  splinters,  the  excision  of  rough  edges,  and  the  elevation  of  the 
depressed  bone,  in  a manner  corresponding  fairly  with  the  primitive 
procedure.  Accordingly,  if  these  cases  stood  by  themselves,  they 
would  appear  to  indicate  rational  therapeutic  surgery;  and  the  indica- 
tion of  the  operation  coinciding  with  pathologic  lesion  (cranium  2)  is 
similar.  The  second  category  is  represented  by  cranium  19,  in  which 
the  wound  was  apparently  a depressed  fracture,  with  extensive  stellate 
Assuring — i.  e.,  a wound  in  which  trephining  would  be  indicated  to 
modern  practitioners,  unless  the  symptoms  permitted  diagnosis  of  the 
great  extension  of  one  of  these  fissures  through  the  orbital  and  nasal 
bones.  Accordingly,  this  example  also  suggests  rational  therapeutic 
motive,  and  the  suggestion  is  greatly  strengthened  by  the  use  of  a 
plate.  In  the  third  category,  represented  by  crania  16  and  17,  on  the 
other  hand,  the  treatment  was  not  only  barbarous  and  clumsy,  but  ill 
directed.  In  the  first  example  the  wound  was  of  such  character  as  to 
contraindicate  trephining,  while  in  the  second  it  was  of  such  nature 
as  to  require  a treatment  quite  different  from  that  adopted.  As 
already  noted,  this  and  several  other  cases  demonstrate  ignorance  of 
physiology  and  etiology  on  the  part  of  the  operators.  They  might,  per- 
haps, be  regarded  as  representing  the  efforts  of  specially  bungling 
practitioners,  though  there  is  nothing  save  the  treatment  in  the  three 
or  four  foregoing  cases  to  suggest  greater  skill  on  the  part  of  any  of 
the  practitioners ; and  accordingly  these  examples  can  hardly  be  con- 
sidered to  represent  a rational  therapeutic  surgery.  On  the  whole, 
this  group  of  crania,  taken  by  themselves,  appear  at  first  sight,  albeit 
somewhat  doubtfully,  to  represent  definite  therapeutic  treatment;  yet 
it  is  to  be  observed  that  their  testimony  is  indicative  or  merely  sugges- 
tive rather  than  conclusive. 

On  considering  the  outcome  of  the  treatment  exemplified  in  the  six 
cases,  a significant  relation  appears — three  of  the  victims  died  under 
the  knife  early  in  the  operation,  two  more  died  before  the  aimless 
hacking  and  scraping  was  completed,  and  the  sixth  died  after  the  oper- 
ation was  completed  but  before  the  beginning  of  reparative  process  in 
the  bone.  Thus  none  of  the  subjects  of  the  suggested  therapeutic 
treatment  survived.  It  is  true  that  in  three  of  the  cases  the  wounds 
were  almost  necessarily  fatal,  and  that  in  the  others  they  were  so  seri- 
ous as  probably  to  result  fatally  without  prompt  and  judicious  treat- 
ment, yet  the  fact  remains  that  the  collection  shows  absolutely  no  basis 
for  the  encouragement  of  trephining  as  a therapeutic  treatment  for 
traumatic  lesions. 

Accordingly,  on  full  consideration  of  all  of  the  facts  and  relations 
displayed  by  the  group  of  crania  in  which  the  operations  were  located 


MCSlZ— MC  GEE] 


MOTIVE  APPARENTLY  THAUMATURGIC 


69 


by  antecedent  wounds,  the  question  arises  whether — superficial  indica- 
tions to  the  contrary  notwithstanding — there  is  any  definite  indication 
that  the  trephining  was  therapeutic;  on  the  one  hand,  there  is  (1)  the 
association  in  place  and  the  sequence  in  time  of  lesion  and  cutting, 
and  (2)  the  fact  that  in  two  or  three  cases  trephining  was  adapted  to 
the  relief  of  the  wound;  on  the  other  hand,  there  is  (1)  the  aberrant 
location  of  the  cutting  and  the  reckless  exploration  in  two  cases;  (2) 
the  ignorance  of  physiology  and  etiology  demonstrated  by  these  and 
other  specimens,  and  (3)  the  invariable  failure  of  the  operation,  regarded 
as  a curative  treatment.  On  the  whole,  it  would  appear,  even  when 
attention  is  confined  to  the  inherent  evidence  of  this  most  suggestive 
portion  of  the  collection,  exceedingly  doubtful  whether  the  cranial 
cutting  can  iustly  be  considered  therapeutic. 

Neglecting  cranium  2 (in  which  there  are  doubtful  indications  of 
location  of  the  operation  by  pathologic  lesions),  there  remain  11  crania, 
displaying  16  operations,  none  of  which  can  be  traced  to  antecedent 
lesions  of  any  sort.  In  these  cases,  therefore,  there  is  no  suggestion 
of  motive.  Accordingly,  it  seems  needful  and  unobjectionable  to  seek 
explanation  of  these  operations  in  the  records  concerning  other  peoples 
of  corresponding  cultural  development.  For  immediate  explanation, 
it  will  suffice  to  consider  the  primitive  operation  performed  among  the 
South  Sea  islanders  by  scraping  with  stone  or  shell  and  covering  with 
plates  of  cocoanut  shell.  Among  them  the  operation  is  not  designed 
to  relieve  traumatic  lesions,  so  far  as  the  records  show,  but  to  relieve 
various  neural  and  cerebral  disorders,  such  as  vertigo  and  even  simple 
headache  ; and  the  operation  is  performed  by  the  shaman.  Now,  while 
the  records  concerning  the  South  Sea  islanders  are  adequate  so  far  as 
procedure  and  results  are  concerned,  there  are  clear  indications  that 
the  recorders  did  not  so  fully  enter  into  the  ideas  of  the  operators  as 
to  understand  the  motives  by  which  they  were  actuated ; but  the  motives 
can  easilybe  inferred  from  those  actuating  the  shamans  amongother  peo- 
ples of  the  same  culture- grade.  Among  the  Indians  of  North  America 
and  South  America,  among  the  Australian  aborigines,  among  several 
native  African  tribes,  and  among  different  Eurasian  peoples  after  the 
dawn  of  history,  the  shamanistic  diagnosis  and  motive  were  closely 
similar.  The  medicine  man  ascribed  the  disorder  to  an  evil  u mystery,’’ 
often  an  imaginary  worm,  sometimes  an  inanimate  foreign  body,  lodged  in 
the  flesh,  bone,  marrow,  brain,  or  intestines  of  the  sufferer,  and  the  treat- 
ment consisted  in  the  exorcism  or  extraction  of  the  foreign  organism  or 
substance  by  incantation,  sometimes  accompanied  by  local  manipulation 
or  other  treatment;  and  among  those  tribes  in  which  this  notion  of 
disease  and  its  treatment  culminated,  the  imaginary  maleficent  organ- 
ism or  substance  was  commonly  symbolized  by  an  actual  worm  or  grub, 
or  a pebble,  or  a bit  of  wood  or  other  substance,  which  the  shaman  dex- 
terously manipulated  in  such  manner  as  to  convey  to  the  lay  observers 
the  impression  that  it  was  taken  from  the  body  of  the  sufferer.  As 


70 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


culture  advanced,  the  materialization  or  incarnation  of  the  evil  “mys- 
tery” declined,  yet  the  primitive  theory  of  disease  persisted  long,  and 
indeed  crops  out  today  in  the  lower  strata  of  civilization  in  every 
country  on  the  globe;  and  medicine  men  and  medicine- women,  wearing 
the  mantles  of  the  shamans  of  old,  treat  disease  by  incantation  and 
exorcism,  perhaps  accompanied  by  simple  medication  or  manipulation, 
which  not  infrequently  chances  to  be  beneficial.  Thus,  although  the 
records  of  trephining  among  the  South  Sea  islanders  are  in  one  respect 
incomplete,  there  can  be  little  doubt  as  to  the  motive  underlying  the 
operation.  Interpreted  in  the  light  of  invariable  ideation  among  primi- 
tive peoples,  the  motive  must  be  considered  thaumaturgic,  and  the 
actuating  idea  the  design  of  liberating  some  maleficent  “mystery”  by  a 
ceremonial  incantation  grown  into  local  treatment  of  unusual  severity; 
and  in  view  of  the  unanimity  of  motive  among  all  primitive  peoples,  so 
far  as  known,  it  seems  not  only  just  and  safe  but  necessary  to  ascribe 
to  the  ancient  practitioners  of  Peru  the  motives  of  other  American 
Indians  as  well  as  the  methods  of  the  South  Sea  islanders.  Thus  the 
16  apparently  erratic  and  aimless  operations  displayed  in  these  11 
crania  find  a rational  and  adequate  explanation;  the  treatment  may 
have  been  for  vertigo,  headache,  or  other  disease;  for  coma,  produced 
by  shocks  or  blows  of  such  character  as  to  leave  no  marks,  or  for  tri- 
lling wounds;  but  it  is  safe  to  consider  the  trephining  thaumaturgic 
and  (albeit  perchance  beneficial)  wholly  independent  of  physiologic 
knowledge  and  etiologic  skill. 

On  considering  the  relation  of  this  group  of  operations  to  individual 
history,  it  appears  that  at  least  6 out  of  16  were  so  far  successful  that 
the  subjects  survived  for  years,  as  attested  by  growth  of  bone,  and  that 
at  least  1 and  perhaps  5 more  survived  for  shorter  periods,  giving  a 
ratio  of  success  quite  as  high  as  that  attending  modern  practice;  so 
that,  whatever  the  motive  in  detail,  there  was  adequate  prestige  for  the 
practitioners  and  adequate  encouragement  for  continuing  the  practice. 

Recurring  now  to  the  5 or  6 crania  displaying  antecedent  lesions 
associated  with  the  operations,  and  considering  the  cases  in  the  light 
of  the  almost  inevitable  inferences  concerning  contemporary  treatment 
in  other  cases,  a suggestion  arises  as  to  the  special  motive  in  these 
individual  cases.  The  suggestion  is  that  the  victims  were  treated  not  so 
much  for  the  wounds,  which  the  skilless  practitioner  was  unable  prop- 
erly to  diagnose,  as  for  the  symptoms  attending  the  lesions.  Pursuing 
this  suggestion,  it  appears  that  in  every  case  the  wounds  were  of  such 
character  as  to  produce  coma,  delirium,  or  other  functional  derangement 
so  serious  as  completely  to  control  the  conduct  of  the  individual — i.  e.,  to 
produce  in  exaggerated  degree  such  disorders  as  are  habitually  treated 
by  the  South  Sea  islanders.  Assuming  the  treatment  to  have  been 
actuated  in  this  way,  its  localization,  sometimes  accurate  but  as  often 
erratic,  is  easily  understood;  for  no  shaman  is  so  completely  dominated 
by  his  ideals  as  to  neglect  local  indications.  A parallel  case  in  which 


muniz  mc gee]  OPERATIONS  PROBABLY  FOR  MENTAL  SYMPTOMS 


71 


a gangrenous  wound  in  tlie  foot  of  an  Indian  was  treated  by  incision 
through  the  flesh  and  scraping  of  the  boue  in  order  to  extract  a maleficent 
maggot  has  been  recorded  by  Cushing.1 

CLASSIFICATION  OF  PERUVIAN  TREPHINING 

On  reviewing  the  foregoing  evidence  as  to  the  culture-grade  and 
antiquity  of  the  Peruvian  practitioners  whose  professional  work  is 
recorded  in  the  Muniz  collection,  it  becomes  clear  that  the  instruments 
were  chiefly  or  wholly  of  stone,  and  hence  that  the  culture-grade  was 
uncivilized;  and  since  the  use  of  metal  quickly  followed  the  Spanish 
invasion,  it  follows  that  the  trephining  must  be  considered  prehistoric. 
This  conclusion  is  sustained  and  established  by  the  associations  with 
the  other  products  of  Dr  Muniz’  work. 

On  reviewing  the  evidence  as  to  method,  it  appears  that  there  is  no 
indication  of  the  useof  differentiated  instruments  or  of  skillful  procedure. 
It  follows  that  the  trephining  must  be  regarded  as  primitive  rather  than 
specialized;  and,  since  the  operation  is  known  from  collateral  evidence 
to  have  been  performed  in  prehistoric  times,  it  must  be  regarded  as 
archaic. 

On  reviewing  the  indications  of  motive,  it  is  found  that  the  evidence 
is  somewhat  vague  and  illusive,  yet,  when  considered  comparatively, 
fairly  satisfactory.  There  are  suggestions  of  therapeutic  treatment  in 
a few  of  the  crania,  yet  on  the  whole  stronger  indications  that  even 
in  these  cases  the  operations  were  thaumaturgic,  while  in  the  great 
majority  of  the  specimens  the  operations  can  only  be  interpreted  as 
wholly  thaumaturgic;  and,  since  there  is  nothing  to  indicate  different 
culture- grades  or  differentiated  methods,  it  seems  necessary  to  conclude 
that  all  the  operations  belong  to  the  earlier  stage  in  the  development 
of  sophiology,  and  were  essentially  thaumaturgic.  It  is  clear  that  most 
of  the  operations  were  ante  mortem,  and  there  is  nothing  to  indicate 
that  any  were  post-mortem.  At  the  same  time  there  is,  in  several 
cases,  conclusive  evidence  that  the  motive  for  the  treatment  was  con- 
nected— albeit  in  a thaumaturgic  way — with  the  individual  treated, 


'This  case  is  especially  significant  as  an  indication  of  theory  and  procedure  in  primitive  surgery. 
The  disorder  was  a tumor  resulting  from  a local  bruise,  so  advanced  as  to  disorganize  tissues  and 
threaten  general  septicemia.  The  theory  was  that  a “mysterious”  maggot  or  worm,  burrowing  in 
flesh  or  bone,  caused  this  disorder.  The  treatment  was  wholly  thaumaturgic  in  plan,  though  partly 
(and  incidentally)  therapeutic  in  procedure.  It  began  with  the  making  of  scalpels  and  lancets  from 
bottle  glass  and  obsidian,  and  with  many  incantations ; next  the  tumor  was  cleansed ; then  a T-skape 
incision  was  made  in  such  manner  as  to  lay  open  the  tumor,  and  the  pus  and  serum  were  removed 
and  the  gangrenous  tissue  cut  away,  exposing  the  bone,  with  discolored  periosteum,  which  was  care- 
fully scraped.  At  this  stage  a fetich,  symbolizing  the  “mysterious  ” maggot,  was  laid  in  the  wound 
and  presently  removed  ceremoniously.  Afterward  the  wound  was  repeatedly  cleansed,  sprayed  with 
a red  infusion  of  willow-root  bark,  and  dried  with  scraped  buckskin;  finally  the  openings  were  stuffed 
and  closed  with  pinon  gum  and  neatly  bandaged,  the  dressing  being  dusted  with  an  astringent  yellow 
powder.  The  infusion,  gum,  and  powder  were  antiseptic,  and  combined  with  the  excision  of  diseased 
tissue  to  effect  a cure ; yet  the  theory  controlling  the  use  of  these  substances  was  no  more  rational  than 
the  primary  diagnosis:  The  red  infusion  symbolized  healthy  blood  or  vitality,  the  gum  symbolized 
constructive  process  (in  prescriptorial  ideation),  and  the  powder  symbolized  fructifying  pollen.  The 
complete  cure  was  due  partly  to  subsequent  dieting,  which  was  incidentally  hygienic,  though  the 
design  was,  like  that  of  the  treatment,  -wholly  symbolic  or  thaumaturgic.  The  bearing  of  this  ease 
on  primitive  trephining  is  manifest.  (“A  Case  of  Primitive  Surgery,”  Science , N.  s.,  vol.  V,  1897.) 


PRIMITIVE  TREPHINING  IN  PERU 


[ETH.  ANN.  16 


72 

while  there  is  not  the  slightest  indication  that  the  operation  was 
vicarious  in  any  case.  Accordingly  the  motive  must  be  subclassed  as 
sortilegie. 

SIGNIFICANCE  OF  PERUVIAN  TREPHINING 

As  set  forth  on  earlier  pages,  trephining  began  in  early  prehistoric 
times,  and  was  performed  after  death  for  the  purpose  of  obtaining 
amulets.  It  seems  necessary  to  conclude  that  the  operation  was  grad- 
ually extended  to  living  captives  for  the  same  vicarious  purpose,  and  it 
seems  certain  that  the  operation  was  extended  in  turn  to  others  than 
captives  for  slightly  modified  yet  still  essentially  vicarious  purposes. 
On  this  part  of  the  development  of  trephining  the  Peruvian  specimens 
do  not  seem  to  bear  directly. 

As  noted  above  incidentally,  there  is  an  important  stage  in  the  devel- 
opment of  medical  and  surgical  practice  in  which  the  motive  is  wholly 
thaumaturgic,  yet  in  which  the  incantation  is  accompanied  by  medi- 
cation or  manipulation;  and  it  may  be  added  that  there  are  numberless 
known  instances  in  Avhich  the  manipulation  is  of  great  severity,  extend- 
ing to  scarification,  penetration  of  the  tissues,  incision  of  the  bone,  and 
actual  trephining.  Sometimes  the  manipulation  is  beneficial,  when  the 
prestige  of  the  shaman  grows,  and  the  aimless  operation  is  thereby 
encouraged  until,  if  frequently  successful,  it  grows  into  empiricism, 
the  forerunner  of  scientific  medicine.  There  is  thus  a gradual  transi- 
tion from  purely  thaumaturgic  manipulation  into  empiric  surgery. 
Now,  it  would  appear  that  the  Peruvian  trephining  represents  some 
stage  in  this  transition;  and  nothing  more  than  inspection  of  the  ill- 
planned,  clumsy,  and  extravagant  cutting  is  required  to  show  that  the 
stage  was  early,  and  that  the  empiricism  in  which  the  pupil  imitates 
the  teacher  and  the  son  the  sire  could  hardly  have  been  reached. 
Accordingly,  Peruvian  trephining  marks  one  of  the  stages  in  the 
development  of  this  branch  of  medical  treatment,  and  indeed  of  med- 
ical treatment  in  general;  and  it  falls  in  place  with  the  other  known 
instances  of  primitive  trephining,  running  from  the  vicarious  operation 
of  prehistoric  times  to  the  empiric  operation  of  the  present  day,  to 
illustrate  and  demonstrate  the  rise  of  the  art  of  trephination. 

As  already  noted,  trephining  is  perhaps  the  boldest  feature  of  mod- 
ern surgery;  and  it  may  be  characterized  as  the  only  feature  of  modern 
surgery  which  is  known  to  be  of  great  antiquity.  Accordingly,  tre- 
phining may  be  considered  to  represent  the  trunk  of  the  genetic  tree 
of  surgery,  and  the  history  of  trephining  may  fairly  be  considered  to 
represent  the  history  of  surgery,  at  any  rate  until  within  recent 
decades;  and  this  history  demonstrates  that  at  least  the  major  opera- 
tions of  surgery  were  in  the  beginning  performed  on  the  dead,  later  on 
those  whose  lives  were  deemed  worthless,  and  only  in  relatively  mod- 
ern periods  for  the  alleviation  of  suffering  and  the  prolongation  of  life. 
Thus  the  Peruvian  collection  is  of  special  note  as  a record  of  an 
important  period  in  the  unwritten  history  of  surgery. 


